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_form_model_desc	mrx_tier_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	7	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	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	7	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	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	7	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	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												
H0028	004	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	004	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	004	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	004	0	1	01	01	H0028_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												
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	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	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	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												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	011	0	1	01	01	H0028_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					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	011	0	1	01	01	H0028_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	011	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	011	0	1	01	01	H0028_011_0	5	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				74.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	011	0	1	01	01	H0028_011_0	5	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	013	0	1	01	01	H0028_013_0	3	Preferred Generic	4	11	3	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												
H0028	013	0	1	01	01	H0028_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	013	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	013	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	013	0	1	01	01	H0028_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												
H0028	014	0	1	01	01	H0028_014_0	5	Preferred Generic	4	11	3	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												
H0028	014	0	1	01	01	H0028_014_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	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 Drug, Specialty Tier												
H0028	015	0	1	01	01	H0028_015_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												
H0028	015	0	1	01	01	H0028_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	015	0	1	01	01	H0028_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	015	0	1	01	01	H0028_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	015	0	1	01	01	H0028_015_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												
H0028	016	0	1	01	01	H0028_016_0	4	Preferred Generic	4	11	3	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												
H0028	016	0	1	01	01	H0028_016_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	01	01	H0028_016_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	01	01	H0028_016_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	01	01	H0028_016_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												
H0028	017	0	1	01	01	H0028_017_0	4	Preferred Generic	4	11	3	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												
H0028	017	0	1	01	01	H0028_017_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_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												
H0028	018	0	1	01	01	H0028_018_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												
H0028	018	0	1	01	01	H0028_018_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	018	0	1	01	01	H0028_018_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	018	0	1	01	01	H0028_018_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	018	0	1	01	01	H0028_018_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												
H0028	019	0	1	01	01	H0028_019_0	5	Preferred Generic	4	11	3	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												
H0028	019	0	1	01	01	H0028_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	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 Drug, Specialty Tier												
H0028	020	0	1	01	01	H0028_020_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												
H0028	020	0	1	01	01	H0028_020_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	020	0	1	01	01	H0028_020_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	020	0	1	01	01	H0028_020_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	020	0	1	01	01	H0028_020_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												
H0028	021	0	1	01	01	H0028_021_0	4	Preferred Generic	4	11	3	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												
H0028	021	0	1	01	01	H0028_021_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_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												
H0028	022	0	1	01	01	H0028_022_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												
H0028	022	0	1	01	01	H0028_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	022	0	1	01	01	H0028_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	022	0	1	01	01	H0028_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	022	0	1	01	01	H0028_022_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	023	0	1	01	01	H0028_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					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												
H0028	023	0	1	01	01	H0028_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_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	024	0	1	01	01	H0028_024_0	5	Preferred Generic	4	11	3	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	024	0	1	01	01	H0028_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_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												
H0028	025	1	1	01	01	H0028_025_1	4	Preferred Generic	4	11	3	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												
H0028	025	1	1	01	01	H0028_025_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	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												
H0028	025	2	1	01	01	H0028_025_2	4	Preferred Generic	4	11	3	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												
H0028	025	2	1	01	01	H0028_025_2	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	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												
H0028	026	1	1	01	01	H0028_026_1	5	Preferred Generic	4	11	3	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	026	1	1	01	01	H0028_026_1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	026	1	1	01	01	H0028_026_1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	026	1	1	01	01	H0028_026_1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	026	1	1	01	01	H0028_026_1	5	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												
H0028	026	2	1	01	01	H0028_026_2	5	Preferred Generic	4	11	3	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	026	2	1	01	01	H0028_026_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	026	2	1	01	01	H0028_026_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	026	2	1	01	01	H0028_026_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	026	2	1	01	01	H0028_026_2	5	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												
H0028	027	0	1	01	01	H0028_027_0	4	Preferred Generic	4	11	3	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												
H0028	027	0	1	01	01	H0028_027_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_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												
H0028	028	0	1	01	01	H0028_028_0	5	Preferred Generic	4	11	3	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	028	0	1	01	01	H0028_028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_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												
H0028	029	0	1	01	01	H0028_029_0	5	Preferred Generic	4	11	3	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	029	0	1	01	01	H0028_029_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_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												
H0028	030	0	1	01	01	H0028_030_0	4	Preferred Generic	4	11	3	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	030	0	1	01	01	H0028_030_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_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												
H0028	031	0	1	01	01	H0028_031_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	031	0	1	01	01	H0028_031_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	031	0	1	01	01	H0028_031_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	031	0	1	01	01	H0028_031_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	031	0	1	01	01	H0028_031_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												
H0028	032	0	1	01	01	H0028_032_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												
H0028	032	0	1	01	01	H0028_032_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	032	0	1	01	01	H0028_032_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	032	0	1	01	01	H0028_032_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	032	0	1	01	01	H0028_032_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												
H0028	033	0	1	01	01	H0028_033_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												
H0028	033	0	1	01	01	H0028_033_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	033	0	1	01	01	H0028_033_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	033	0	1	01	01	H0028_033_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	033	0	1	01	01	H0028_033_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												
H0028	034	0	1	01	01	H0028_034_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	034	0	1	01	01	H0028_034_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	034	0	1	01	01	H0028_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	034	0	1	01	01	H0028_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	034	0	1	01	01	H0028_034_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												
H0028	035	0	1	01	01	H0028_035_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					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												
H0028	035	0	1	01	01	H0028_035_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	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 Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_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	036	0	1	01	01	H0028_036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_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												
H0028	037	0	1	01	01	H0028_037_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												
H0028	037	0	1	01	01	H0028_037_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_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												
H0028	038	0	1	01	01	H0028_038_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												
H0028	038	0	1	01	01	H0028_038_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	038	0	1	01	01	H0028_038_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	038	0	1	01	01	H0028_038_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	038	0	1	01	01	H0028_038_0	5	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												
H0028	039	0	1	01	01	H0028_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					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												
H0028	039	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_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												
H0028	040	0	1	01	01	H0028_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					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												
H0028	040	0	1	01	01	H0028_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	040	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	040	0	1	01	01	H0028_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	040	0	1	01	01	H0028_040_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												
H0028	041	0	1	01	01	H0028_041_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												
H0028	041	0	1	01	01	H0028_041_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_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												
H0028	042	0	1	01	01	H0028_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					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												
H0028	042	0	1	01	01	H0028_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_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												
H0028	043	1	1	01	01	H0028_043_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					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												
H0028	043	1	1	01	01	H0028_043_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_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												
H0028	043	2	1	01	01	H0028_043_2	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												
H0028	043	2	1	01	01	H0028_043_2	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	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												
H0062	001	0	1	01	01	H0062_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 Drug, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_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	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												
H0062	001	0	1	01	01	H0062_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 Drug, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_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	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 Drug, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	6	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, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	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																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_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 Drug, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_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, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	6	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, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_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	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, Select Care Drugs												
H0062	003	0	1	01	01	H0062_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																			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												
H0062	003	0	1	01	01	H0062_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																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_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	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 Drug, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_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, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_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 Drug, Specialty Tier, Select Care Drugs												
H0062	004	0	1	01	01	H0062_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	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	004	0	1	01	01	H0062_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	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												
H0062	004	0	1	01	01	H0062_004_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 Drug, Specialty Tier, Select Care Drugs												
H0062	004	0	1	01	01	H0062_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	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 Drug, Specialty Tier, Select Care Drugs												
H0062	004	0	1	01	01	H0062_004_0	6	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, Select Care Drugs												
H0062	004	0	1	01	01	H0062_004_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	005	0	1	01	01	H0062_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	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	005	0	1	01	01	H0062_005_0	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																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	005	0	1	01	01	H0062_005_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 Drug, Specialty Tier, Select Care Drugs												
H0062	005	0	1	01	01	H0062_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		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												
H0062	005	0	1	01	01	H0062_005_0	5	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, Select Care Drugs												
H0062	005	0	1	01	01	H0062_005_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 Drug, Specialty Tier, Select Care Drugs												
H0062	009	0	1	01	01	H0062_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	1.00	2.00	3.00																			0.67	1.33	2.00																1.00				1.00		0.03			0.02			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	009	0	1	01	01	H0062_009_0	5	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																			5.33	10.67	16.00																8.00				8.00		0.27			0.18			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	009	0	1	01	01	H0062_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	42.00	84.00	126.00																			28.00	56.00	84.00																42.00				42.00		1.40			0.93			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	009	0	1	01	01	H0062_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		31	85.00	170.00	255.00																			56.67	113.33	170.00																85.00				85.00		2.83			1.89			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	009	0	1	01	01	H0062_009_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, Select Care Drugs												
H0062	009	0	1	01	01	H0062_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	010	0	1	01	01	H0062_010_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				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	010	0	1	01	01	H0062_010_0	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																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	010	0	1	01	01	H0062_010_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																			43.67	87.33	131.00																47.00				47.00		1.57			1.46			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	010	0	1	01	01	H0062_010_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																			96.67	193.33	290.00																100.00				100.00		3.33			3.22			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	010	0	1	01	01	H0062_010_0	5	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, Select Care Drugs												
H0062	010	0	1	01	01	H0062_010_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 Drug, Specialty Tier, Select Care Drugs												
H0088	001	0	1	04	01	H0088_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0088	001	0	1	04	01	H0088_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0088	001	0	1	04	01	H0088_001_0	4	Generic	4	11	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		0.00				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		94.00				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				89.89	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					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0104	012	0	1	04	01	H0104_012_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					3.00		6.00					3.00		6.00																3.00				3.00			0.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_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					13.00		26.00					13.00		26.00																13.00				13.00			0.66	0.43	0.43			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_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					40.00		80.00					40.00		80.00																40.00				40.00			1.56	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											40.00	50		50				35.00	45		45				45		45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	4	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 Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_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			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	4	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								2.00		6.00					2.00		4.00					4.00		8.00																2.00				2.00			0.06	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0104	014	0	1	04	01	H0104_014_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					3.00		6.00					3.00		6.00																3.00				3.00			0.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_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					13.00		26.00					13.00		26.00																13.00				13.00			0.66	0.43	0.43			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_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					40.00		80.00					40.00		80.00																40.00				40.00			1.56	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											43.00	50		50				37.00	45		45				45		45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	4	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 Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_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			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	4	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								2.00		6.00					2.00		4.00					4.00		8.00																2.00				2.00			0.06	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0104	015	0	1	04	01	H0104_015_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					3.00		6.00					3.00		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												
H0104	015	0	1	04	01	H0104_015_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					8.00		16.00					8.00		16.00																15.00				15.00			0.50	0.26	0.26			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_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					40.00		80.00					40.00		80.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											43.00	50		50				37.00	45		45				45		45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	3	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 Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	3	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 Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	3	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								2.00		6.00					2.00		4.00					4.00		8.00																2.00				2.00			0.07	0.07	0.13			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
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	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												25		25					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	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												
H0107	004	0	1	04	01	H0107_004_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		
H0107	004	0	1	04	01	H0107_004_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												
H0107	004	0	1	04	01	H0107_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					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	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												
H0107	004	0	1	04	01	H0107_004_0	6	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					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	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	001	0	1	04	01	H0111_001_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H0111	001	0	1	04	01	H0111_001_0	5	Generic	4	11	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		0.00				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	5	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												
H0111	001	0	1	04	01	H0111_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				63.65	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	5	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												
H0111	002	0	1	04	01	H0111_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	002	0	1	04	01	H0111_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H0111	002	0	1	04	01	H0111_002_0	4	Generic	4	11	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		0.00				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		90.00				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				63.58	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					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0137	001	0	1	48	05	H0137_001_0	2	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	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	2	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	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	2	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	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	2	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	0.00	3.40					0.00	3.40			
H0148	001	0	1	48	05	H0148_001_0	2	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	0.00	8.50					0.00	8.50			
H0148	001	0	1	48	05	H0148_001_0	2	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	2	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	0.00	3.40					0.00	3.40			
H0148	002	0	1	48	05	H0148_002_0	2	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	0.00	8.50					0.00	8.50			
H0148	002	0	1	48	05	H0148_002_0	2	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			
H0154	011	0	1	01	01	H0154_011_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					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	5	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	5	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	16.00	24.00				7.00	13.50	16.00				8.00				8.00			0.27	0.27		0.27	0.23	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	5	Generic	4	01	1	2	2	3		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	16.00	24.00				7.00	13.50	16.00				8.00				8.00			0.27	0.27		0.27	0.23	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0154	011	0	1	01	01	H0154_011_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	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											93.33	50	50	50				93.33	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	5	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	7	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0154	012	0	1	01	01	H0154_012_0	7	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0154	012	0	1	01	01	H0154_012_0	7	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0154	012	0	1	01	01	H0154_012_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				0.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0154	012	0	1	01	01	H0154_012_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				0.00	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0154	012	0	1	01	01	H0154_012_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												
H0154	012	0	1	01	01	H0154_012_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		
H0154	014	0	1	01	01	H0154_014_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					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	5	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	014	0	1	01	01	H0154_014_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	30.00				8.50	17.00	20.00				10.00				10.00			0.33	0.33		0.33	0.28	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_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	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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.37	50	50	50				97.37	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	5	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	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					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	7	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	015	1	1	01	01	H0154_015_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					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	015	1	1	01	01	H0154_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	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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.82	45	45	45				99.82	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	7	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	31						1.00	31																							31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	2	1	01	01	H0154_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					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	7	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	015	2	1	01	01	H0154_015_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					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	015	2	1	01	01	H0154_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	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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.82	45	45	45				99.82	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	7	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	31						1.00	31																							31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	016	0	1	01	01	H0154_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								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	016	0	1	01	01	H0154_016_0	5	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	016	0	1	01	01	H0154_016_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	30.00				8.50	17.00	20.00				10.00				10.00			0.33	0.33		0.33	0.28	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	016	0	1	01	01	H0154_016_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	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	016	0	1	01	01	H0154_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											97.47	50	50	50				97.47	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	016	0	1	01	01	H0154_016_0	5	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												
H0174	001	0	1	01	01	H0174_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	001	0	1	01	01	H0174_001_0	3	Generic	3	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	18.00		45.00																									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												
H0174	001	0	1	01	01	H0174_001_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		117.50																									47.00		117.50				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												
H0174	001	0	1	01	01	H0174_001_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.38	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	001	0	1	01	01	H0174_001_0	3	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												
H0174	002	0	1	01	01	H0174_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	002	0	1	01	01	H0174_002_0	5	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		12.50																									5.00		12.50				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												
H0174	002	0	1	01	01	H0174_002_0	5	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		87.50																									35.00		87.50				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	002	0	1	01	01	H0174_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		187.50																									75.00		187.50				75.00		150.00				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	002	0	1	01	01	H0174_002_0	5	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												
H0174	003	0	1	01	01	H0174_003_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	003	0	1	01	01	H0174_003_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0174	003	0	1	01	01	H0174_003_0	3	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		12.50																									5.00		12.50				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												
H0174	003	0	1	01	01	H0174_003_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		87.50																									35.00		87.50				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	003	0	1	01	01	H0174_003_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		187.50																									75.00		187.50				75.00		150.00				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	003	0	1	01	01	H0174_003_0	3	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												
H0174	004	0	1	01	01	H0174_004_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	004	0	1	01	01	H0174_004_0	3	Generic	3	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		30.00																									12.00		30.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	004	0	1	01	01	H0174_004_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		117.50																									47.00		117.50				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												
H0174	004	0	1	01	01	H0174_004_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				87.55	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	004	0	1	01	01	H0174_004_0	3	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												
H0174	005	0	1	02	01	H0174_005_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	005	0	1	02	01	H0174_005_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0174	005	0	1	02	01	H0174_005_0	3	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		12.50																									5.00		12.50				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												
H0174	005	0	1	02	01	H0174_005_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		75.00																									30.00		75.00				30.00		60.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	005	0	1	02	01	H0174_005_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				72.72	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	005	0	1	02	01	H0174_005_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 Drug, Specialty Tier												
H0174	006	0	1	01	01	H0174_006_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	006	0	1	01	01	H0174_006_0	3	Generic	3	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	18.00		45.00																									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												
H0174	006	0	1	01	01	H0174_006_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		117.50																									47.00		117.50				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												
H0174	006	0	1	01	01	H0174_006_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.66	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	006	0	1	01	01	H0174_006_0	3	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												
H0174	007	0	1	01	01	H0174_007_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	007	0	1	01	01	H0174_007_0	3	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		17.50																									7.00		17.50				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												
H0174	007	0	1	01	01	H0174_007_0	3	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		75.00																									30.00		75.00				30.00		60.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	007	0	1	01	01	H0174_007_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				73.74	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	007	0	1	01	01	H0174_007_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 Drug, Specialty Tier												
H0192	001	0	1	48	05	H0192_001_0	6	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	6	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	6	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			
H0270	001	0	1	04	01	H0270_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	001	0	1	04	01	H0270_001_0	3	Generic	4	11	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		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	001	0	1	04	01	H0270_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	001	0	1	04	01	H0270_001_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		198.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	001	0	1	04	01	H0270_001_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 Drug, Specialty Tier												
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	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	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			
H0292	001	0	1	01	01	H0292_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					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												
H0292	001	0	1	01	01	H0292_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	001	0	1	01	01	H0292_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	001	0	1	01	01	H0292_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	001	0	1	01	01	H0292_001_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												
H0292	002	0	1	01	01	H0292_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					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												
H0292	002	0	1	01	01	H0292_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_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												
H0294	002	0	1	04	01	H0294_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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				2	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				2	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				2	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				2	2						90	30		31				1037.00	27		27																										27						27			27			27								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				2	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				2	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				2	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				2	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				2	2						90	30		31				949.00	26		26																										26						26			26			26								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				2	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				2	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				2	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				2	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				2	2						90	30		31				784.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				857.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				1043.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	7	Preferred Generic	4	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												
H0302	001	0	1	01	01	H0302_001_0	7	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	7	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	7	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	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 Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	6	Preferred Generic	4	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												
H0302	006	0	1	01	01	H0302_006_0	6	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	6	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	6	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	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 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		6.00																					6.00																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					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	009	0	1	01	01	H0302_009_0	7	Preferred Generic	4	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												
H0302	009	0	1	01	01	H0302_009_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	009	0	1	01	01	H0302_009_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	009	0	1	01	01	H0302_009_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	009	0	1	01	01	H0302_009_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								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	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	004	0	1	02	01	H0332_004_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	004	0	1	02	01	H0332_004_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	004	0	1	02	01	H0332_004_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	004	0	1	02	01	H0332_004_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	004	0	1	02	01	H0332_004_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												
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	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	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	6	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 Drug, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	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 Drug, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_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					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 Drug, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_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		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 Drug, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_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, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	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	7.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_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					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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_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					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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	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					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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	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	7.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_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					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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_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					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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	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					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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	3	1	01	01	H0351_044_3	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	7.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	044	3	1	01	01	H0351_044_3	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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	3	1	01	01	H0351_044_3	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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	3	1	01	01	H0351_044_3	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					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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	3	1	01	01	H0351_044_3	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 Drug, Specialty Tier, Select Care Drugs												
H0351	044	3	1	01	01	H0351_044_3	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 Drug, Specialty Tier, Select Care Drugs												
H0351	050	0	1	01	01	H0351_050_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 Drug, Specialty Tier, Select Care Drugs												
H0351	050	0	1	01	01	H0351_050_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 Drug, Specialty Tier, Select Care Drugs												
H0351	050	0	1	01	01	H0351_050_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 Drug, Specialty Tier, Select Care Drugs												
H0351	050	0	1	01	01	H0351_050_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					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 Drug, Specialty Tier, Select Care Drugs												
H0351	050	0	1	01	01	H0351_050_0	3	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	050	0	1	01	01	H0351_050_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 Drug, Specialty Tier, Select Care Drugs												
H0351	051	0	1	01	01	H0351_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								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 Drug, Specialty Tier, Select Care Drugs												
H0351	051	0	1	01	01	H0351_051_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 Drug, Specialty Tier, Select Care Drugs												
H0351	051	0	1	01	01	H0351_051_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 Drug, Specialty Tier, Select Care Drugs												
H0351	051	0	1	01	01	H0351_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					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 Drug, Specialty Tier, Select Care Drugs												
H0351	051	0	1	01	01	H0351_051_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, Select Care Drugs												
H0351	051	0	1	01	01	H0351_051_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 Drug, 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								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												
H0354	001	0	1	01	01	H0354_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								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										1		
H0354	001	0	1	01	01	H0354_001_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	16.00											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 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	2	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												
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	2	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				100.00				100.00			3.33	3.17		3.33	3.17	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											713.32	29						368.56	29												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								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												
H0354	024	0	1	01	01	H0354_024_0	6	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 Drug, Specialty Tier										1		
H0354	024	0	1	01	01	H0354_024_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	16.00											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 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	2	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												
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	2	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				100.00				100.00			3.33	3.17		3.33	3.17	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											827.44	33						428.34	33												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								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, Select Diabetic Drugs												
H0354	027	0	1	01	01	H0354_027_0	6	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 Drug, Specialty Tier, Select Diabetic Drugs										1		
H0354	027	0	1	01	01	H0354_027_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	16.00											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 Drug, Specialty Tier, Select Diabetic Drugs												
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	2	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, Select Diabetic Drugs												
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	2	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				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
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											661.15	29						489.31	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0354	027	0	1	01	01	H0354_027_0	6	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	33.00					9.00	18.00	9.00											11.00	22.00	33.00				9.00	18.00	9.00				11.00				11.00			0.37	0.30		0.37	0.30	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0354	028	0	1	01	01	H0354_028_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	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												
H0354	028	0	1	01	01	H0354_028_0	6	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 Drug, Specialty Tier										1		
H0354	028	0	1	01	01	H0354_028_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	10.00											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 Drug, Specialty Tier												
H0354	028	0	1	01	01	H0354_028_0	6	Preferred Brand	4	11	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											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												
H0354	028	0	1	01	01	H0354_028_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											100.00	200.00	300.00				95.00	190.00	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												
H0354	028	0	1	01	01	H0354_028_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											881.61	33						474.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	001	0	1	02	01	H0422_001_0	4	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					3.00		9.00											12.00		24.00				3.00		6.00					12.00			12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	001	0	1	02	01	H0422_001_0	4	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					15.00		45.00											20.00		40.00				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												
H0422	001	0	1	02	01	H0422_001_0	4	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					42.00		126.00											47.00		94.00				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												
H0422	001	0	1	02	01	H0422_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											75.09	50		50				67.58	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	001	0	1	02	01	H0422_001_0	4	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1636.77	25		25				1636.77	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	002	0	1	02	01	H0422_002_0	5	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					3.00		9.00											12.00		24.00				3.00		6.00					12.00			12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	002	0	1	02	01	H0422_002_0	5	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					15.00		45.00											20.00		40.00				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												
H0422	002	0	1	02	01	H0422_002_0	5	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					42.00		126.00											47.00		94.00				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												
H0422	002	0	1	02	01	H0422_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											71.81	50		50				64.63	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	002	0	1	02	01	H0422_002_0	5	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2550.63	33		33				2550.63	33		33										33		33				33		33				33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	001	0	1	01	01	H0432_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				870.00	32		32																										32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	002	0	1	01	01	H0432_002_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				877.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				850.00	32		32																										32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	004	0	1	01	01	H0432_004_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				877.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				850.00	32		32																										32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	006	0	1	01	01	H0432_006_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				877.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				850.00	32		32																										32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	008	0	1	01	01	H0432_008_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				877.00	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	6	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				3.00	6.00	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												
H0439	003	1	1	01	01	H0439_003_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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	6	Preferred Brand	4	11	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											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												
H0439	003	1	1	01	01	H0439_003_1	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.66	50	50	50				67.93	50	50	50										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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											614.27	27						530.12	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	6	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				3.00	6.00	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												
H0439	003	2	1	01	01	H0439_003_2	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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	6	Preferred Brand	4	11	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											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												
H0439	003	2	1	01	01	H0439_003_2	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.66	50	50	50				67.93	50	50	50										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	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											614.27	27						530.12	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	02	01	H0439_006_0	6	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 Drug, Specialty Tier												
H0439	006	0	1	02	01	H0439_006_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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	02	01	H0439_006_0	6	Preferred Brand	4	11	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											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												
H0439	006	0	1	02	01	H0439_006_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.69	45	45	45				81.12	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	02	01	H0439_006_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											803.38	33						599.58	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_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					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												
H0473	001	0	1	04	01	H0473_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_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												
H0473	002	0	1	04	01	H0473_002_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												
H0473	002	0	1	04	01	H0473_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	002	0	1	04	01	H0473_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	002	0	1	04	01	H0473_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	002	0	1	04	01	H0473_002_0	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 Drug, Specialty Tier												
H0480	001	0	1	48	05	H0480_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	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	8	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	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	8	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			
H0504	015	0	1	01	01	H0504_015_0	4	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 Drug, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	4	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 Drug, Injectable Drugs, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_0	4	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	4	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	4	Preferred Brand	4	11	1	2	3	3		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	4	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											107.54	25	25	25				107.54	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_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	017	0	1	01	01	H0504_017_0	2	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 Drug, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	2	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 Drug, Injectable Drugs, Specialty Tier										1		
H0504	017	0	1	01	01	H0504_017_0	2	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	2	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										1		
H0504	017	0	1	01	01	H0504_017_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	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	2	Preferred Brand	4	11	1	2	3	3		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										2	3	
H0504	017	0	1	01	01	H0504_017_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	2	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											98.11	28	28	28				98.11	28	28	28						28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_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												
H0504	021	0	1	01	01	H0504_021_0	2	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	021	0	1	01	01	H0504_021_0	2	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	021	0	1	01	01	H0504_021_0	2	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	2	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										1		
H0504	021	0	1	01	01	H0504_021_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	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	2	Preferred Brand	4	11	1	2	3	3		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										2	3	
H0504	021	0	1	01	01	H0504_021_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	2	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											98.54	31	31	31				98.54	31	31	31						31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_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												
H0504	026	0	1	01	01	H0504_026_0	2	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 Drug, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	2	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 Drug, Injectable Drugs, Specialty Tier										1		
H0504	026	0	1	01	01	H0504_026_0	2	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	2	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										1		
H0504	026	0	1	01	01	H0504_026_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	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	2	Preferred Brand	4	11	1	2	3	3		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										2	3	
H0504	026	0	1	01	01	H0504_026_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	2	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											81.12	33	33	33				81.12	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_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												
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								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 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								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 Drug, Injectable Drugs, Specialty Tier										1		
H0504	028	0	1	01	01	H0504_028_0	4	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	4	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										1		
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	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	3		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										1		
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	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											97.94	26	26	26				97.94	26	26	26						26															26			26								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	01	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	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	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	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											96.77	26	26	26				96.77	26	26	26						26															26			26								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	01	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	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	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	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											96.75	25	25	25				96.75	25	25	25						25															25			25								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	2	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	2	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_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	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	2	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											99.92	28	28	28				99.92	28	28	28						28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	2	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	3	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	3	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	038	0	1	01	01	H0504_038_0	3	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	038	0	1	01	01	H0504_038_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	038	0	1	01	01	H0504_038_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	038	0	1	01	01	H0504_038_0	3	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											98.41	29	29	29				98.41	29	29	29						29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	038	0	1	01	01	H0504_038_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 Drug, Injectable Drugs, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	3	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	3	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	3	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								15.00	30.00	45.00					10.00	20.00	15.00							15.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	3	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								15.00	30.00	45.00					10.00	20.00	15.00							15.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										1		
H0504	039	0	1	01	01	H0504_039_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	3	Preferred Brand	4	11	1	2	3	3		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										1		
H0504	039	0	1	01	01	H0504_039_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	3	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											98.39	30	30	30				98.39	30	30	30						30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_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 Drug, Injectable Drugs, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	4	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 Drug, Injectable Drugs, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	4	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 Drug, Injectable Drugs, Specialty Tier										1		
H0504	040	0	1	01	01	H0504_040_0	4	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	4	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										1		
H0504	040	0	1	01	01	H0504_040_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	4	Preferred Brand	4	11	1	2	3	3		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier										1		
H0504	040	0	1	01	01	H0504_040_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	4	Injectable Drugs	4	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											98.40	31	31	31				98.40	31	31	31						31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_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												
H0523	002	0	1	01	01	H0523_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								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												
H0523	002	0	1	01	01	H0523_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								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		
H0523	002	0	1	01	01	H0523_002_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H0523	002	0	1	01	01	H0523_002_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H0523	002	0	1	01	01	H0523_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	002	0	1	01	01	H0523_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												
H0523	002	0	1	01	01	H0523_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												
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								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												
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								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		
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	2	Preferred Generic	4	01	1	2	1	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												
H0523	031	0	1	01	01	H0523_031_0	2	Preferred Generic	4	01	1	2	1	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		
H0523	031	0	1	01	01	H0523_031_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H0523	031	0	1	01	01	H0523_031_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H0523	031	0	1	01	01	H0523_031_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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								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												
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								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		
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	061	0	1	01	01	H0523_061_0	2	Preferred Generic	4	01	1	2	1	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												
H0523	061	0	1	01	01	H0523_061_0	2	Preferred Generic	4	01	1	2	1	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		
H0523	061	0	1	01	01	H0523_061_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H0523	061	0	1	01	01	H0523_061_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H0523	061	0	1	01	01	H0523_061_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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												
H0523	063	0	1	01	01	H0523_063_0	2	Preferred Generic	4	01	1	2	1	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		
H0523	063	0	1	01	01	H0523_063_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H0523	063	0	1	01	01	H0523_063_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H0523	063	0	1	01	01	H0523_063_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	063	0	1	01	01	H0523_063_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	002	0	2	01	01	H0524_002_0	7	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	7	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	002	0	2	01	01	H0524_002_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				1916.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_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	002	0	2	01	01	H0524_002_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	003	0	1	01	01	H0524_003_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				1846.00	33	33	33																		33	33	33															33			33								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	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				1785.00	33	33	33																		33	33	33															33			33								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	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	8	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	8	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	8	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	8	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	8	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2314.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_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	010	0	2	01	01	H0524_010_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	013	0	1	01	01	H0524_013_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2146.00	33	33	33																		33	33	33															33			33								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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				1871.00	33	33	33																		33	33	33															33			33								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	6	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	Generic	3	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	17.00	34.00	51.00																			17.00	34.00	34.00																17.00				17.00		0.56			0.56			0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	Preferred Brand	3	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	Non-Preferred Brand	3	10	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				1615.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	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	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2228.00	33	33	33																		33	33	33															33			33								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	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2278.00	33	33	33																		33	33	33															33			33								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	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2071.00	33	33	33																		33	33	33															33			33								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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	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	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2216.00	33	33	33																		33	33	33															33			33								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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2031.00	33	33	33																		33	33	33															33			33								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	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	7	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	7	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				1994.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_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	036	0	1	01	01	H0524_036_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	037	0	1	01	01	H0524_037_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	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	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2299.00	33	33	33																		33	33	33															33			33								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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2267.00	33	33	33																		33	33	33															33			33								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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	16.00	32.00	48.00																			16.00	32.00	32.00																16.00				16.00		0.53			0.53			0.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	16.00	32.00	48.00																			16.00	32.00	32.00																16.00				16.00		0.53			0.53			0.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2186.00	33	33	33																		33	33	33															33			33								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	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	7	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	7	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				1965.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_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	040	0	1	01	01	H0524_040_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	041	0	1	01	01	H0524_041_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	7	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	7	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2192.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_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	041	0	1	01	01	H0524_041_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	042	0	1	01	01	H0524_042_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2055.00	33	33	33																		33	33	33															33			33								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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2332.00	33	33	33																		33	33	33															33			33								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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	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	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				1621.00	33	33	33																		33	33	33															33			33								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	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	051	0	1	01	01	H0524_051_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				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 Brand, Specialty Tier, Vaccines										1		
H0524	051	0	1	01	01	H0524_051_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	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	111		01	111		1	30	60	100				2	2	30	60	100				30		31				1870.00	33	33	33																		33	33	33															33			33								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		
H0524	054	0	1	01	01	H0524_054_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	6.00	12.00	18.00																			3.00	6.00	6.00																6.00				6.00		0.20			0.10			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	6.00	12.00	18.00																			3.00	6.00	6.00																6.00				6.00		0.20			0.10			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	054	0	1	01	01	H0524_054_0	7	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	18.00	36.00	54.00																			10.00	20.00	20.00																18.00				18.00		0.60			0.33			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	7	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	18.00	36.00	54.00																			10.00	20.00	20.00																18.00				18.00		0.60			0.33			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	054	0	1	01	01	H0524_054_0	7	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				2179.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_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	054	0	1	01	01	H0524_054_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		
H0543	001	0	1	01	01	H0543_001_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	001	0	1	01	01	H0543_001_0	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						24.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				776.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	013	0	1	01	01	H0543_013_0	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				768.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	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				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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				854.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				801.00	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				2	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				2	2						90	30		31	12.00		36.00																											36.00						12.00				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				2	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				2	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				2	2						90	30		31				653.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				525.00	26		26																										26						26			26			26								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				2	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				2	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				2	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				2	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				2	2						90	30		31				936.00	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				2	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				2	2						90	30		31	12.00		36.00																											36.00						12.00				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				2	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				2	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				2	2						90	30		31				756.00	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				2	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				2	2						90	30		31	12.00		36.00																											36.00						12.00				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				2	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				2	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				2	2						90	30		31				822.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				802.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				630.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				725.00	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				2	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				2	2						90	30		31	10.00		30.00																											30.00						10.00				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				2	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				2	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				2	2						90	30		31				732.00	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				2	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				2	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				2	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	138	0	1	01	01	H0543_138_0	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	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										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				2	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				2	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				2	2						90	30		31				763.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				769.00	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				2	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				2	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				2	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	144	0	1	01	01	H0543_144_0	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	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										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				2	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				2	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				2	2						90	30		31				926.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				861.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1022.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1028.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				629.00	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				2	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												
H0543	151	0	1	01	01	H0543_151_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						24.00				12.00				12.00		0.40						0.38	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				2	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				2	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				2	2						90	30		31				737.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				971.00	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	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				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	5	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						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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				704.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	163	0	1	01	01	H0543_163_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				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	5	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						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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1011.00	28		28																										28						28			28			28								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				2	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				2	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				2	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				2	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				2	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				2	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				2	2						90	30		31				800.00	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				2	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				2	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				2	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				2	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				2	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				2	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				2	2						90	30		31				749.00	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				2	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				2	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				2	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				2	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				2	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				2	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				2	2						90	30		31				914.00	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	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	5	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						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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				863.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	01	01	H0543_168_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H0543	168	0	1	01	01	H0543_168_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	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		
H0543	168	0	1	01	01	H0543_168_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	168	0	1	01	01	H0543_168_0	4	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	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										1		
H0543	168	0	1	01	01	H0543_168_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	01	01	H0543_168_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	168	0	1	01	01	H0543_168_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				800.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	01	01	H0543_169_0	4	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	01	01	H0543_169_0	4	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	169	0	1	01	01	H0543_169_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	169	0	1	01	01	H0543_169_0	4	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	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	169	0	1	01	01	H0543_169_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	01	01	H0543_169_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	169	0	1	01	01	H0543_169_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				749.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	01	01	H0543_170_0	4	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	01	01	H0543_170_0	4	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	170	0	1	01	01	H0543_170_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	170	0	1	01	01	H0543_170_0	4	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	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	170	0	1	01	01	H0543_170_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	01	01	H0543_170_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	170	0	1	01	01	H0543_170_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				914.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	175	0	1	01	01	H0543_175_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	175	0	1	01	01	H0543_175_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	175	0	1	01	01	H0543_175_0	5	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	175	0	1	01	01	H0543_175_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	175	0	1	01	01	H0543_175_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1011.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	01	01	H0543_176_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	176	0	1	01	01	H0543_176_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	01	01	H0543_176_0	5	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	01	01	H0543_176_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	176	0	1	01	01	H0543_176_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				677.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	01	01	H0543_177_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	177	0	1	01	01	H0543_177_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	01	01	H0543_177_0	5	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	01	01	H0543_177_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	177	0	1	01	01	H0543_177_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1008.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	01	01	H0543_178_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	178	0	1	01	01	H0543_178_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	01	01	H0543_178_0	5	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	01	01	H0543_178_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	178	0	1	01	01	H0543_178_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				547.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	01	01	H0543_179_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	179	0	1	01	01	H0543_179_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	01	01	H0543_179_0	5	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	01	01	H0543_179_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	179	0	1	01	01	H0543_179_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				634.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	002	0	1	01	01	H0544_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, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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	003	0	1	01	01	H0544_003_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	003	0	1	01	01	H0544_003_0	7	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	7	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	7	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	7	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	7	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	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	003	0	1	01	01	H0544_003_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	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	7	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	7	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	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												
H0544	007	0	1	01	01	H0544_007_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																					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	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	007	0	1	01	01	H0544_007_0	7	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	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												
H0544	008	0	1	01	01	H0544_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							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	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												
H0544	008	0	1	01	01	H0544_008_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		
H0544	008	0	1	01	01	H0544_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					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	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												
H0544	008	0	1	01	01	H0544_008_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												
H0544	008	0	1	01	01	H0544_008_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												
H0544	008	0	1	01	01	H0544_008_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	
H0544	010	0	1	01	01	H0544_010_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							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	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							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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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							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	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							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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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												
H0544	015	0	1	01	01	H0544_015_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		
H0544	015	0	1	01	01	H0544_015_0	9	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	9	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	9	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	9	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	9	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	9	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	9	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	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							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	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							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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	8	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	8	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	8	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	8	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	8	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	8	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	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							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	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							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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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							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	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							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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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							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	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							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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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							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	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							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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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							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	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							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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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							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	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							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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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							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	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							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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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							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	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							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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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	050	0	1	01	01	H0544_050_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	050	0	1	01	01	H0544_050_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		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	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		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	7	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	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	050	0	1	01	01	H0544_050_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	050	0	1	01	01	H0544_050_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	050	0	1	01	01	H0544_050_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										2	2	
H0544	052	0	1	01	01	H0544_052_0	9	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	052	0	1	01	01	H0544_052_0	9	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	052	0	1	01	01	H0544_052_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					8.00	16.00	24.00					8.00		24.00																8.00				8.00			0.27	0.27	0.27			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	052	0	1	01	01	H0544_052_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	053	0	1	01	01	H0544_053_0	9	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	9	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	053	0	1	01	01	H0544_053_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00		30.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	054	0	1	01	01	H0544_054_0	9	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	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	9	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0544	054	0	1	01	01	H0544_054_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								16.00	32.00	48.00					16.00	32.00	48.00					16.00		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												
H0544	054	0	1	01	01	H0544_054_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	054	0	1	01	01	H0544_054_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	9	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	9	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	055	0	1	01	01	H0544_055_0	9	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	055	0	1	01	01	H0544_055_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					9.00	18.00	27.00					9.00		27.00																9.00				9.00			0.30	0.30	0.30			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	055	0	1	01	01	H0544_055_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	056	0	1	01	01	H0544_056_0	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	056	0	1	01	01	H0544_056_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	10	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	11	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	057	0	1	01	01	H0544_057_0	11	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	057	0	1	01	01	H0544_057_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00		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	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	11	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	11	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	058	0	1	01	01	H0544_058_0	11	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	058	0	1	01	01	H0544_058_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	058	0	1	01	01	H0544_058_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	11	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	10	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	059	0	1	01	01	H0544_059_0	10	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	059	0	1	01	01	H0544_059_0	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	059	0	1	01	01	H0544_059_0	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	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												
H0544	060	3	1	01	01	H0544_060_3	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00		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	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	11	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	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00		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	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	060	4	1	01	01	H0544_060_4	10	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	10	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00		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	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	061	0	1	01	01	H0544_061_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	9	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	062	0	1	01	01	H0544_062_0	10	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	062	0	1	01	01	H0544_062_0	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		20.00																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	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	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												
H0544	063	0	1	01	01	H0544_063_0	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	11	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	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	064	0	1	01	01	H0544_064_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	10	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								5.00	10.00	15.00					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	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00		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	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	11	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	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	11	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	066	0	1	01	01	H0544_066_0	11	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	066	0	1	01	01	H0544_066_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	066	0	1	01	01	H0544_066_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	11	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	11	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	067	0	1	01	01	H0544_067_0	11	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	067	0	1	01	01	H0544_067_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	067	0	1	01	01	H0544_067_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	11	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	10	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	069	0	1	01	01	H0544_069_0	10	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	069	0	1	01	01	H0544_069_0	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	070	0	1	01	01	H0544_070_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	070	0	1	01	01	H0544_070_0	9	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	070	0	1	01	01	H0544_070_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					9.00	18.00	27.00					9.00		27.00																9.00				9.00			0.30	0.30	0.30			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	070	0	1	01	01	H0544_070_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	071	0	1	01	01	H0544_071_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	071	0	1	01	01	H0544_071_0	9	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	071	0	1	01	01	H0544_071_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					8.00	16.00	24.00					8.00		24.00																8.00				8.00			0.27	0.27	0.27			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	071	0	1	01	01	H0544_071_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	072	0	1	01	01	H0544_072_0	9	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	072	0	1	01	01	H0544_072_0	9	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	072	0	1	01	01	H0544_072_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					9.00	18.00	27.00					9.00		27.00																9.00				9.00			0.30	0.30	0.30			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	072	0	1	01	01	H0544_072_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	074	0	1	01	01	H0544_074_0	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H0544	074	0	1	01	01	H0544_074_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	10	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	081	0	1	01	01	H0544_081_0	9	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	081	0	1	01	01	H0544_081_0	9	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	081	0	1	01	01	H0544_081_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								2.00	4.00	6.00					2.00	4.00	6.00					2.00		6.00																2.00				2.00			0.07	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	081	0	1	01	01	H0544_081_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	081	0	1	01	01	H0544_081_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	081	0	1	01	01	H0544_081_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												
H0544	087	0	1	01	01	H0544_087_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	9	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	087	0	1	01	01	H0544_087_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					8.00	16.00	24.00					8.00		24.00																8.00				8.00			0.27	0.27	0.27			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	087	0	1	01	01	H0544_087_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	087	0	1	01	01	H0544_087_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												
H0544	088	0	1	01	01	H0544_088_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	088	0	1	01	01	H0544_088_0	9	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	088	0	1	01	01	H0544_088_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00		30.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	088	0	1	01	01	H0544_088_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	088	0	1	01	01	H0544_088_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	088	0	1	01	01	H0544_088_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												
H0544	089	0	1	01	01	H0544_089_0	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	089	0	1	01	01	H0544_089_0	10	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	089	0	1	01	01	H0544_089_0	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00		21.00																7.00				7.00			0.23	0.23	0.23			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	089	0	1	01	01	H0544_089_0	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	089	0	1	01	01	H0544_089_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	089	0	1	01	01	H0544_089_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												
H0544	090	0	1	01	01	H0544_090_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	090	0	1	01	01	H0544_090_0	9	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	090	0	1	01	01	H0544_090_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00		30.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	090	0	1	01	01	H0544_090_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	090	0	1	01	01	H0544_090_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	090	0	1	01	01	H0544_090_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												
H0544	091	0	1	01	01	H0544_091_0	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	11	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	091	0	1	01	01	H0544_091_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00		14.00																12.00				12.00			0.40	0.23	0.23			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	11	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												
H0545	001	0	1	01	01	H0545_001_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	001	0	1	01	01	H0545_001_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	001	0	1	01	01	H0545_001_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	001	0	1	01	01	H0545_001_0	5	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		90				2	1			90				30		31				69.01	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	001	0	1	01	01	H0545_001_0	5	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1452.09	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	012	0	1	01	01	H0545_012_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	012	0	1	01	01	H0545_012_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0545	012	0	1	01	01	H0545_012_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	012	0	1	01	01	H0545_012_0	3	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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	012	0	1	01	01	H0545_012_0	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	012	0	1	01	01	H0545_012_0	3	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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	012	0	1	01	01	H0545_012_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0545	014	0	1	01	01	H0545_014_0	6	Preferred Generic	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0545	014	0	1	01	01	H0545_014_0	6	Generic	2	01	1	1	2	1	110		01	100		1	30		90				2	1			90				30		31				7.45	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0545	014	0	1	01	01	H0545_014_0	6	Preferred Brand	2	10	1	1	3	1	110		01	100		1	30		90				2	1			90				30		31				76.65	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0545	014	0	1	01	01	H0545_014_0	6	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	1			90				30		31				124.01	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0545	014	0	1	01	01	H0545_014_0	6	Specialty Tier	2	11	1	1	5	1	010		01			1	30														30		31				862.52	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	009	0	1	01	01	H0562_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								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 Drug, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_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					7.00	14.00	21.00					7.00	14.00	14.00																18.00				18.00			0.60	0.23	0.23			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_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 Drug, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_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, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_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 Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_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								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 Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_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	60.00					12.00	24.00	36.00					12.00	24.00	24.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_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								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 Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_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, Select Care Drugs												
H0562	012	0	1	01	01	H0562_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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	3	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					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, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	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	57.00					12.00	24.00	36.00					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												
H0562	039	0	1	01	01	H0562_039_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 Drug, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_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, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_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 Drug, 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 Drug, 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 Drug, 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 Drug, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_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												
H0562	055	0	1	01	01	H0562_055_0	4	Specialty Tier	3	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, 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 Drug, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_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	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_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, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_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 Drug, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	3	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, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_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 Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_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 Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_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, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_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 Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_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, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_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 Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_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 Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_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					13.00	26.00	39.00					13.00	26.00	26.00																18.00				18.00			0.60	0.43	0.43			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_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 Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_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, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_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 Drug, 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					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 Drug, 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					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 Drug, 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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_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, 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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_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 Drug, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	3	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					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, Select Care Drugs										1		
H0562	092	0	1	01	01	H0562_092_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					10.00	20.00	30.00					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, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	3	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					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, Select Care Drugs										1		
H0562	092	0	1	01	01	H0562_092_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 Drug, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_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, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_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 Drug, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0562	097	0	1	01	01	H0562_097_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					5.00	10.00	15.00					5.00	10.00	10.00																8.00				8.00			0.27	0.17	0.17			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_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					12.00	24.00	36.00					12.00	24.00	24.00																15.00				15.00			0.50	0.40	0.40			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_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 Drug, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_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, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_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 Drug, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_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					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 Drug, Specialty Tier, Select Care Drugs										1		
H0562	100	1	1	01	01	H0562_100_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	3	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					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 Drug, Specialty Tier, Select Care Drugs										1		
H0562	100	1	1	01	01	H0562_100_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	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, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	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 Drug, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0562	100	2	1	01	01	H0562_100_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_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					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 Drug, Specialty Tier, Select Care Drugs										1		
H0562	100	2	1	01	01	H0562_100_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	3	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					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 Drug, Specialty Tier, Select Care Drugs										1		
H0562	100	2	1	01	01	H0562_100_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	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, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	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 Drug, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0562	101	1	1	01	01	H0562_101_1	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 Drug, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	3	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					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, Select Care Drugs										1		
H0562	101	1	1	01	01	H0562_101_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	3	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					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 Drug, Specialty Tier, Select Care Drugs										1		
H0562	101	1	1	01	01	H0562_101_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	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, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	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 Drug, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_2	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 Drug, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	3	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					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, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	3	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					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 Drug, Specialty Tier, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	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, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	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 Drug, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0562	103	0	1	01	01	H0562_103_0	3	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					8.00	16.00	16.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_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, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_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 Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_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, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_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 Drug, Specialty Tier, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_1	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												
H0562	110	1	1	01	01	H0562_110_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																			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												
H0562	110	1	1	01	01	H0562_110_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																			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												
H0562	110	1	1	01	01	H0562_110_1	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												
H0562	110	1	1	01	01	H0562_110_1	5	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, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	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												
H0562	110	2	1	01	01	H0562_110_2	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																			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												
H0562	110	2	1	01	01	H0562_110_2	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												
H0562	110	2	1	01	01	H0562_110_2	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												
H0562	110	2	1	01	01	H0562_110_2	5	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, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	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												
H0562	110	3	1	01	01	H0562_110_3	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												
H0562	110	3	1	01	01	H0562_110_3	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																			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												
H0562	110	3	1	01	01	H0562_110_3	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												
H0562	110	3	1	01	01	H0562_110_3	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												
H0562	110	3	1	01	01	H0562_110_3	5	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, Select Care Drugs												
H0562	110	3	1	01	01	H0562_110_3	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												
H0562	111	1	1	01	01	H0562_111_1	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												
H0562	111	1	1	01	01	H0562_111_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																			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												
H0562	111	1	1	01	01	H0562_111_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																			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												
H0562	111	1	1	01	01	H0562_111_1	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												
H0562	111	1	1	01	01	H0562_111_1	5	Specialty Tier	3	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, Select Care Drugs												
H0562	111	1	1	01	01	H0562_111_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	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												
H0562	111	2	1	01	01	H0562_111_2	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																			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												
H0562	111	2	1	01	01	H0562_111_2	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												
H0562	111	2	1	01	01	H0562_111_2	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												
H0562	111	2	1	01	01	H0562_111_2	5	Specialty Tier	3	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, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	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												
H0562	111	3	1	01	01	H0562_111_3	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												
H0562	111	3	1	01	01	H0562_111_3	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																			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												
H0562	111	3	1	01	01	H0562_111_3	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												
H0562	111	3	1	01	01	H0562_111_3	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												
H0562	111	3	1	01	01	H0562_111_3	5	Specialty Tier	3	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, Select Care Drugs												
H0562	111	3	1	01	01	H0562_111_3	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												
H0562	112	0	1	01	01	H0562_112_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_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					5.00	10.00	15.00					5.00	10.00	10.00																20.00				20.00			0.67	0.17	0.17			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_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 Drug, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_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, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_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 Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_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 Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_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					10.00	20.00	30.00					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, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_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 Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_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, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_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 Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_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					12.00	24.00	36.00					12.00	24.00	24.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_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 Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_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, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_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 Drug, Specialty Tier, Select Care Drugs												
H0562	116	0	1	01	01	H0562_116_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 Drug, Specialty Tier, Select Care Drugs												
H0562	116	0	1	01	01	H0562_116_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					10.00	20.00	30.00					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, Select Care Drugs												
H0562	116	0	1	01	01	H0562_116_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 Drug, Specialty Tier, Select Care Drugs												
H0562	116	0	1	01	01	H0562_116_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					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 Drug, Specialty Tier, Select Care Drugs												
H0562	116	0	1	01	01	H0562_116_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, Select Care Drugs												
H0562	116	0	1	01	01	H0562_116_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 Drug, Specialty Tier, Select Care Drugs												
H0571	001	0	1	01	01	H0571_001_0	4	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	4	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	4	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	4	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	4	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1076.00	29		29																										29						29			29			29								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				2	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				2	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				2	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				2	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				2	2						90	30		31				906.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				902.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				994.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				1008.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				753.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				877.00	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				2	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				2	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				2	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				2	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				2	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				2	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				2	2						100	30		31				916.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	031	0	1	01	01	H0609_031_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	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	031	0	1	01	01	H0609_031_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	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	031	0	1	01	01	H0609_031_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	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	031	0	1	01	01	H0609_031_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	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		3
H0609	031	0	1	01	01	H0609_031_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	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	031	0	1	01	01	H0609_031_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	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	031	0	1	01	01	H0609_031_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		100				2	2						100	30		31				904.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	01	01	H0609_032_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	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	032	0	1	01	01	H0609_032_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	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	032	0	1	01	01	H0609_032_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		100				2	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	032	0	1	01	01	H0609_032_0	3	Generic	4	01	1	2	2	3	110		01		100	1	30		100				2	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	032	0	1	01	01	H0609_032_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	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	032	0	1	01	01	H0609_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	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	032	0	1	01	01	H0609_032_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		100				2	2						100	30		31				985.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	01	01	H0609_033_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	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												
H0609	033	0	1	01	01	H0609_033_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		100				2	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												
H0609	033	0	1	01	01	H0609_033_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	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	033	0	1	01	01	H0609_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	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	033	0	1	01	01	H0609_033_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		100				2	2						100	30		31				740.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0630	013	0	1	01	01	H0630_013_0	16	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	16	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	013	0	1	01	01	H0630_013_0	16	Generic	4	11	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		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	16	Generic	4	11	1	2	2	3	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		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	013	0	1	01	01	H0630_013_0	16	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		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	16	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	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	16	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				1763.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	16	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	16	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	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			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9	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			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	015	0	1	01	01	H0630_015_0	9	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	17.00	34.00	51.00																			17.00	34.00	34.00																17.00				17.00		0.56			0.56			0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	17.00	34.00	51.00																			17.00	34.00	34.00																17.00				17.00		0.56			0.56			0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	015	0	1	01	01	H0630_015_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		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9	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	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				1702.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9	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	9	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	9	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																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	016	0	1	01	01	H0630_016_0	9	Generic	4	11	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			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	9	Generic	4	11	1	2	2	3	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			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	016	0	1	01	01	H0630_016_0	9	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	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, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	9	Non-Preferred Brand	4	10	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		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				2245.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	9	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	9	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	8	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	5.00	5.00				15.00				15.00			0.50	0.16		0.50	0.16	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	8	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	5.00	5.00				15.00				15.00			0.50	0.16		0.50	0.16	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	017	0	1	01	01	H0630_017_0	8	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					14.00	28.00	42.00											20.00	40.00	60.00				14.00	28.00	28.00				20.00				20.00			0.66	0.46		0.66	0.46	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	8	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					14.00	28.00	42.00											20.00	40.00	60.00				14.00	28.00	28.00				20.00				20.00			0.66	0.46		0.66	0.46	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	017	0	1	01	01	H0630_017_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					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	8	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					93.00	186.00	279.00											100.00	200.00	300.00				93.00	186.00	186.00				100.00				100.00			3.33	3.10		3.33	3.10	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	8	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											2285.00	33	33	33				2285.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_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												
H0630	017	0	1	01	01	H0630_017_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		
H0630	018	0	1	01	01	H0630_018_0	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								14.00	28.00	42.00					4.00	8.00	12.00											14.00	28.00	42.00				5.00	5.00	5.00				14.00				14.00			0.46	0.13		0.46	0.13	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	9	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								14.00	28.00	42.00					4.00	8.00	12.00											14.00	28.00	42.00				5.00	5.00	5.00				14.00				14.00			0.46	0.13		0.46	0.13	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	018	0	1	01	01	H0630_018_0	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	24.00				18.00				18.00			0.60	0.40		0.60	0.40	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	9	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	24.00				18.00				18.00			0.60	0.40		0.60	0.40	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	018	0	1	01	01	H0630_018_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					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	9	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					93.00	186.00	279.00											100.00	200.00	300.00				93.00	186.00	186.00				100.00				100.00			3.33	3.10		3.33	3.10	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	9	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											1683.00	33	33	33				1683.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	9	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												
H0630	018	0	1	01	01	H0630_018_0	9	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		
H0630	020	0	1	01	01	H0630_020_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	9	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	020	0	1	01	01	H0630_020_0	9	Generic	4	11	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		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	9	Generic	4	11	1	2	2	3	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		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	020	0	1	01	01	H0630_020_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		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	9	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	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				2095.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	9	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	9	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	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			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9	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			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	021	0	1	01	01	H0630_021_0	9	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	17.00	34.00	51.00																			17.00	34.00	34.00																17.00				17.00		0.56			0.56			0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	17.00	34.00	51.00																			17.00	34.00	34.00																17.00				17.00		0.56			0.56			0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	021	0	1	01	01	H0630_021_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		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9	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	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				1694.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9	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	9	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	008	0	1	04	01	H0710_008_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1014.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				965.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				954.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				924.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				812.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	042	0	1	04	01	H0710_042_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	042	0	1	04	01	H0710_042_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	042	0	1	04	01	H0710_042_0	3	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	042	0	1	04	01	H0710_042_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	042	0	1	04	01	H0710_042_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				851.00	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	3	Preferred Generic	2	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												
H0712	005	0	1	01	01	H0712_005_0	3	Generic	2	11	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		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_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																									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												
H0712	005	0	1	01	01	H0712_005_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.66	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	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												
H0712	019	0	1	01	01	H0712_019_0	3	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												
H0712	019	0	1	01	01	H0712_019_0	3	Preferred Generic	4	11	1	2	1	3	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										1		
H0712	019	0	1	01	01	H0712_019_0	3	Generic	4	11	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		0.00				12.00				12.00		0.40				0.40	0.40	0.39	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		94.00				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				85.17	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					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	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												
H0712	020	0	1	02	01	H0712_020_0	3	Generic	3	11	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		0.00				7.00				7.00		0.23				0.23	0.23	0.23	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		94.00				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				81.37	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					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	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	021	0	1	01	01	H0712_021_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H0712	021	0	1	01	01	H0712_021_0	3	Generic	4	11	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		0.00				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		94.00				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				90.13	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					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	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	022	0	1	01	01	H0712_022_0	3	Generic	4	11	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		0.00				12.00				12.00		0.40				0.40	0.40	0.39	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	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												
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				56.59	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					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	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	023	0	1	01	01	H0712_023_0	3	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	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		94.00				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				56.77	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					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	024	0	1	01	01	H0712_024_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	024	0	1	01	01	H0712_024_0	3	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	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		94.00				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				56.76	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					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	025	0	1	01	01	H0712_025_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	025	0	1	01	01	H0712_025_0	4	Generic	3	11	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		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	025	0	1	01	01	H0712_025_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		94.00				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	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.34	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	4	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												
H0712	028	0	1	01	01	H0712_028_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	028	0	1	01	01	H0712_028_0	4	Generic	3	11	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		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	028	0	1	01	01	H0712_028_0	4	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		86.00				43.00				43.00		1.43				1.43	1.43	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	028	0	1	01	01	H0712_028_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.37	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	028	0	1	01	01	H0712_028_0	4	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												
H0724	001	0	1	01	01	H0724_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								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 Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	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					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 Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_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					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 Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_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					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 Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	5	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 Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_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 Drug, Specialty Tier, Select Care Drugs												
H0724	002	0	1	01	01	H0724_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								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 Drug, Specialty Tier, Select Care Drugs												
H0724	002	0	1	01	01	H0724_002_0	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					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 Drug, Specialty Tier, Select Care Drugs												
H0724	002	0	1	01	01	H0724_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					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 Drug, Specialty Tier, Select Care Drugs												
H0724	002	0	1	01	01	H0724_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					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 Drug, Specialty Tier, Select Care Drugs												
H0724	002	0	1	01	01	H0724_002_0	5	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 Drug, Specialty Tier, Select Care Drugs												
H0724	002	0	1	01	01	H0724_002_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 Drug, Specialty Tier, Select Care Drugs												
H0724	003	0	1	01	01	H0724_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								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 Drug, Specialty Tier, Select Care Drugs												
H0724	003	0	1	01	01	H0724_003_0	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					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 Drug, Specialty Tier, Select Care Drugs												
H0724	003	0	1	01	01	H0724_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					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 Drug, Specialty Tier, Select Care Drugs												
H0724	003	0	1	01	01	H0724_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					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 Drug, Specialty Tier, Select Care Drugs												
H0724	003	0	1	01	01	H0724_003_0	5	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 Drug, Specialty Tier, Select Care Drugs												
H0724	003	0	1	01	01	H0724_003_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 Drug, Specialty Tier, Select Care Drugs												
H0724	004	0	1	01	01	H0724_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								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 Drug, Specialty Tier, Select Care Drugs												
H0724	004	0	1	01	01	H0724_004_0	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					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 Drug, Specialty Tier, Select Care Drugs												
H0724	004	0	1	01	01	H0724_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								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 Drug, Specialty Tier, Select Care Drugs												
H0724	004	0	1	01	01	H0724_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		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 Drug, Specialty Tier, Select Care Drugs												
H0724	004	0	1	01	01	H0724_004_0	5	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 Drug, Specialty Tier, Select Care Drugs												
H0724	004	0	1	01	01	H0724_004_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 Drug, Specialty Tier, Select Care Drugs												
H0755	030	0	1	01	01	H0755_030_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	030	0	1	01	01	H0755_030_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				977.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	031	0	1	01	01	H0755_031_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				956.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	033	0	1	01	01	H0755_033_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				789.00	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				2	2						90	30		31	2.00		4.00																											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				2	2						90	30		31	12.00		24.00																											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				2	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				2	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				2	2						90	30		31				812.00	28		28																										28						28			28			28								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				2	2						90	30		31	2.00		4.00																											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				2	2						90	30		31	10.00		20.00																											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				2	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				2	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				2	2						90	30		31				885.00	29		29																										29						29			29			29								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				2	2						90	30		31	2.00		4.00																											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				2	2						90	30		31	10.00		20.00																											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				2	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				2	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				2	2						90	30		31				789.00	31		31																										31						31			31			31								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				2	2						90	30		31	2.00		4.00																											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				2	2						90	30		31	12.00		24.00																											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				2	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				2	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				2	2						90	30		31				893.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0838	020	0	1	01	01	H0838_020_0	8	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	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	8	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				11.33	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	8	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				73.58	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	8	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				31.85	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	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	020	0	1	01	01	H0838_020_0	8	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	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	8	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	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	8	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	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	8	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				64.22	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	8	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				31.91	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	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	024	0	1	01	01	H0838_024_0	8	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	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	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	025	0	1	01	01	H0838_025_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	025	0	1	01	01	H0838_025_0	8	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	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	8	Preferred Brand	4	10	1	2	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	025	0	1	01	01	H0838_025_0	8	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	85.00		255.00																					255.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	025	0	1	01	01	H0838_025_0	8	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	8	Select Care Drugs	4	10	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	025	0	1	01	01	H0838_025_0	8	Select Care Drugs	4	10	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	028	0	1	01	01	H0838_028_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	028	0	1	01	01	H0838_028_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	028	0	1	01	01	H0838_028_0	8	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	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	8	Preferred Brand	4	10	1	2	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	028	0	1	01	01	H0838_028_0	8	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	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	8	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	8	Select Care Drugs	4	10	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	028	0	1	01	01	H0838_028_0	8	Select Care Drugs	4	10	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	029	0	1	01	01	H0838_029_0	9	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	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	9	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				8.46	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	9	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				60.16	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	9	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				44.64	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	9	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	9	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	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	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0838	032	0	1	01	01	H0838_032_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	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	8	Preferred Brand	4	10	1	2	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	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	8	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	8	Select Care Drugs	4	10	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	8	Select Care Drugs	4	10	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0838	033	0	1	01	01	H0838_033_0	8	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	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	8	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				9.45	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	8	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				74.09	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	8	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				43.44	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	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	033	0	1	01	01	H0838_033_0	8	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	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	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	037	0	1	01	01	H0838_037_0	9	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	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	9	Preferred Brand	4	10	1	2	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	9	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	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	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	037	0	1	01	01	H0838_037_0	9	Select Care Drugs	4	10	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	9	Select Care Drugs	4	10	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	039	1	1	01	01	H0838_039_1	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	039	1	1	01	01	H0838_039_1	7	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	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	039	1	1	01	01	H0838_039_1	7	Preferred Brand	4	10	1	2	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	7	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	85.00		255.00																					255.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	7	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	039	1	1	01	01	H0838_039_1	7	Select Care Drugs	4	10	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	7	Select Care Drugs	4	10	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	039	2	1	01	01	H0838_039_2	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	039	2	1	01	01	H0838_039_2	8	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	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	039	2	1	01	01	H0838_039_2	8	Preferred Brand	4	10	1	2	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	8	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	85.00		255.00																					255.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	8	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	039	2	1	01	01	H0838_039_2	8	Select Care Drugs	4	10	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	8	Select Care Drugs	4	10	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	040	1	1	01	01	H0838_040_1	8	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	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	040	1	1	01	01	H0838_040_1	8	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				8.58	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	1	1	01	01	H0838_040_1	8	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				79.70	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	1	1	01	01	H0838_040_1	8	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				42.43	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	1	1	01	01	H0838_040_1	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	040	1	1	01	01	H0838_040_1	8	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	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	040	2	1	01	01	H0838_040_2	7	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	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	040	2	1	01	01	H0838_040_2	7	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				8.58	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	2	1	01	01	H0838_040_2	7	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				79.70	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	2	1	01	01	H0838_040_2	7	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				42.43	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	2	1	01	01	H0838_040_2	7	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	040	2	1	01	01	H0838_040_2	7	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	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	041	0	1	01	01	H0838_041_0	8	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	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	041	0	1	01	01	H0838_041_0	8	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				7.50	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	041	0	1	01	01	H0838_041_0	8	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				41.88	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	041	0	1	01	01	H0838_041_0	8	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				33.05	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	041	0	1	01	01	H0838_041_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	041	0	1	01	01	H0838_041_0	8	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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					32																				32																	32			32								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	02	01	H0913_002_0	4	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												
H0913	002	0	1	02	01	H0913_002_0	4	Generic	4	11	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		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	002	0	1	02	01	H0913_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		94.00				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	02	01	H0913_002_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				80.39	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	002	0	1	02	01	H0913_002_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												
H0913	013	0	1	01	01	H0913_013_0	4	Preferred Generic	2	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												
H0913	013	0	1	01	01	H0913_013_0	4	Generic	2	11	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		0.00				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	4	Preferred Brand	2	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	37.00		111.00																									37.00		111.00				37.00		74.00				37.00				37.00		1.23				1.23	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	4	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.04	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	4	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												
H0913	015	0	1	01	01	H0913_015_0	4	Preferred Generic	3	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												
H0913	015	0	1	01	01	H0913_015_0	4	Generic	3	11	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		0.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	015	0	1	01	01	H0913_015_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	015	0	1	01	01	H0913_015_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				80.65	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	015	0	1	01	01	H0913_015_0	4	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												
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	8.50	0.00	8.50			0.00	8.50			
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	8.50	0.00	8.50			0.00	8.50			
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																																														0.00						0.00	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			
H0982	001	0	1	01	01	H0982_001_0	10	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												
H0982	001	0	1	01	01	H0982_001_0	10	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										1		
H0982	001	0	1	01	01	H0982_001_0	10	Generic	4	01	3	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												
H0982	001	0	1	01	01	H0982_001_0	10	Generic	4	01	3	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										1		3
H0982	001	0	1	01	01	H0982_001_0	10	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		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												
H0982	001	0	1	01	01	H0982_001_0	10	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	30.00	60.00	75.00																			30.00	60.00	75.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	001	0	1	01	01	H0982_001_0	10	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				1620.51	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	002	0	1	01	01	H0982_002_0	10	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	002	0	1	01	01	H0982_002_0	10	Preferred Generic	4	01	1	1	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0982	002	0	1	01	01	H0982_002_0	10	Generic	4	01	3	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	002	0	1	01	01	H0982_002_0	10	Generic	4	01	3	1	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H0982	002	0	1	01	01	H0982_002_0	10	Preferred Brand	4	10	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				75.77	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	002	0	1	01	01	H0982_002_0	10	Non-Preferred Brand	4	10	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				108.94	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	002	0	1	01	01	H0982_002_0	10	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				893.83	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	005	0	1	01	01	H0982_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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	005	0	1	01	01	H0982_005_0	9	Preferred Generic	4	01	1	1	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0982	005	0	1	01	01	H0982_005_0	9	Generic	4	01	3	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												
H0982	005	0	1	01	01	H0982_005_0	9	Generic	4	01	3	1	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H0982	005	0	1	01	01	H0982_005_0	9	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	100.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	005	0	1	01	01	H0982_005_0	9	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	85.00	170.00	225.00																			85.00	170.00	225.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	005	0	1	01	01	H0982_005_0	9	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				1738.82	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	006	0	1	01	01	H0982_006_0	9	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	006	0	1	01	01	H0982_006_0	9	Preferred Generic	4	01	1	1	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0982	006	0	1	01	01	H0982_006_0	9	Generic	4	01	3	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	006	0	1	01	01	H0982_006_0	9	Generic	4	01	3	1	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H0982	006	0	1	01	01	H0982_006_0	9	Preferred Brand	4	10	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				75.21	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	006	0	1	01	01	H0982_006_0	9	Non-Preferred Brand	4	10	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				107.59	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	006	0	1	01	01	H0982_006_0	9	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				891.92	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	007	0	1	01	01	H0982_007_0	9	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												
H0982	007	0	1	01	01	H0982_007_0	9	Generic	4	01	3	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												
H0982	007	0	1	01	01	H0982_007_0	9	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 Brand, Specialty Tier												
H0982	007	0	1	01	01	H0982_007_0	9	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																			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												
H0982	007	0	1	01	01	H0982_007_0	9	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				1524.44	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	008	0	1	01	01	H0982_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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	008	0	1	01	01	H0982_008_0	9	Generic	4	01	3	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												
H0982	008	0	1	01	01	H0982_008_0	9	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 Brand, Specialty Tier												
H0982	008	0	1	01	01	H0982_008_0	9	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																			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												
H0982	008	0	1	01	01	H0982_008_0	9	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				1613.76	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	009	0	1	01	01	H0982_009_0	9	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												
H0982	009	0	1	01	01	H0982_009_0	9	Generic	4	01	3	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												
H0982	009	0	1	01	01	H0982_009_0	9	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	100.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	009	0	1	01	01	H0982_009_0	9	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	85.00	170.00	225.00																			85.00	170.00	225.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	009	0	1	01	01	H0982_009_0	9	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				1737.70	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	010	0	1	01	01	H0982_010_0	9	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	010	0	1	01	01	H0982_010_0	9	Preferred Generic	4	01	1	1	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0982	010	0	1	01	01	H0982_010_0	9	Generic	4	01	3	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	010	0	1	01	01	H0982_010_0	9	Generic	4	01	3	1	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H0982	010	0	1	01	01	H0982_010_0	9	Preferred Brand	4	10	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.90	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	010	0	1	01	01	H0982_010_0	9	Non-Preferred Brand	4	10	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				111.73	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0982	010	0	1	01	01	H0982_010_0	9	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				898.23	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	9	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	9	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	9	Generic	4	11	3	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		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	9	Generic	4	11	3	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		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	9	Preferred Brand	4	11	3	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	35.00	70.00	87.50																									35.00	70.00	105.00				35.00	70.00	87.50				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	9	Non-Preferred Drug	4	11	3	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	70.00	140.00	175.00																									70.00	140.00	210.00				70.00	140.00	175.00				70.00				70.00		2.33				2.33	2.33	2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	9	Specialty Tier	4	11	1	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	9	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	9	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	9	Generic	4	11	3	2	2	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	15.00				5.00	10.00	12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	9	Generic	4	11	3	2	2	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	5.00	10.00	12.50																									5.00	10.00	15.00				5.00	10.00	12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	021	0	1	01	01	H1016_021_0	9	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	9	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	9	Specialty Tier	4	11	1	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	023	0	1	01	01	H1016_023_0	13	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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	13	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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	023	0	1	01	01	H1016_023_0	13	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	13	Generic	4	11	3	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	023	0	1	01	01	H1016_023_0	13	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	112.50					30.00	60.00	75.00											45.00	90.00	135.00				30.00	60.00	75.00				45.00				30.00			1.50	1.00		1.50	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	13	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								85.00	170.00	212.50					65.00	130.00	162.50											85.00	170.00	255.00				65.00	130.00	162.50				85.00				65.00			2.83	2.17		2.83	2.17	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	13	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	13	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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	13	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	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	024	0	1	01	01	H1016_024_0	13	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	13	Generic	4	11	3	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	024	0	1	01	01	H1016_024_0	13	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	112.50					35.00	70.00	87.50											45.00	90.00	135.00				35.00	70.00	87.50				45.00				35.00			1.50	1.17		1.50	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	13	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	250.00					75.00	150.00	187.50											100.00	200.00	300.00				75.00	150.00	187.50				100.00				75.00			3.33	2.50		3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	13	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	5	Preferred Generic	4	11	3	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	5	Preferred Generic	4	11	3	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		3
H1019	001	0	1	01	01	H1019_001_0	5	Generic	4	11	1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	5	Generic	4	11	1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	001	0	1	01	01	H1019_001_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	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 Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	3	Preferred Generic	4	11	3	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	3	Preferred Generic	4	11	3	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		3
H1019	006	0	1	01	01	H1019_006_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	3	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	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										1		
H1019	006	0	1	01	01	H1019_006_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_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												
H1019	023	0	1	01	01	H1019_023_0	5	Preferred Generic	4	11	3	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_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	024	0	1	01	01	H1019_024_0	4	Preferred Generic	4	11	3	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	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	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	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	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	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_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	028	0	1	01	01	H1019_028_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	028	0	1	01	01	H1019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	028	0	1	01	01	H1019_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	028	0	1	01	01	H1019_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												
H1019	043	0	1	01	01	H1019_043_0	4	Preferred Generic	4	11	3	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	043	0	1	01	01	H1019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_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					30.00		90.00											47.00		141.00				30.00		80.00				47.00				47.00			1.57	1		1.57	1	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_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												
H1019	054	0	1	01	01	H1019_054_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H1019	054	0	1	01	01	H1019_054_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	054	0	1	01	01	H1019_054_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	054	0	1	01	01	H1019_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												
H1019	057	0	1	01	01	H1019_057_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H1019	057	0	1	01	01	H1019_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	057	0	1	01	01	H1019_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					30.00		90.00											47.00		141.00				30.00		80.00				47.00				47.00			1.57	1		1.57	1	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	01	01	H1019_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_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												
H1019	060	0	1	01	01	H1019_060_0	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	060	0	1	01	01	H1019_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	060	0	1	01	01	H1019_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					60.00		180.00											100.00		300.00				60.00		170.00				100.00				100.00			3.33	2		3.33	2	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	060	0	1	01	01	H1019_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												
H1019	065	0	1	01	01	H1019_065_0	4	Preferred Generic	4	11	3	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	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					0.00		0.00											12.00		36.00				0.00		0.00				12.00				12.00			0.40	0		0.40	0	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_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												
H1019	069	0	1	01	01	H1019_069_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H1019	069	0	1	01	01	H1019_069_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	069	0	1	01	01	H1019_069_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_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												
H1019	073	0	1	01	01	H1019_073_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_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												
H1019	076	0	1	01	01	H1019_076_0	4	Preferred Generic	4	11	3	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	4	Generic	4	11	1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_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												
H1019	077	0	1	01	01	H1019_077_0	3	Preferred Generic	4	11	3	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	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	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	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	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	3	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	1	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	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	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	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	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	081	0	1	01	01	H1019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	081	0	1	01	01	H1019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	081	0	1	01	01	H1019_081_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	083	0	1	01	01	H1019_083_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_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	085	0	1	01	01	H1019_085_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_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												
H1019	089	0	1	01	01	H1019_089_0	4	Preferred Generic	4	11	3	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	089	0	1	01	01	H1019_089_0	4	Preferred Generic	4	11	3	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		3
H1019	089	0	1	01	01	H1019_089_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	089	0	1	01	01	H1019_089_0	4	Generic	4	11	1	1	2	3		110	01		110	1				30		90	2	2				30		90	30		31											8.00	17		17				0.00	0		0										17		17				0		0			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	089	0	1	01	01	H1019_089_0	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	25		25				32.00	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											47.00	25		25				45.00	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	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	090	0	1	01	01	H1019_090_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	090	0	1	01	01	H1019_090_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	090	0	1	01	01	H1019_090_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	090	0	1	01	01	H1019_090_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												
H1019	091	0	1	01	01	H1019_091_0	3	Preferred Generic	4	11	3	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	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	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	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	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	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	092	0	1	01	01	H1019_092_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	092	0	1	01	01	H1019_092_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	092	0	1	01	01	H1019_092_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												
H1019	094	0	1	01	01	H1019_094_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_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												
H1019	097	0	1	01	01	H1019_097_0	4	Preferred Generic	4	11	3	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	097	0	1	01	01	H1019_097_0	4	Generic	4	11	1	1	2	1		110	01		110	1				30		90	2	2				30		90	30		31											6.00	25		25				6.00	24		24										25		25				24		24			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	097	0	1	01	01	H1019_097_0	4	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	25		25				35.00	24		24										25		25				24		24			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	097	0	1	01	01	H1019_097_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											51.00	25		25				49.00	24		24										25		25				24		24			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	097	0	1	01	01	H1019_097_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												
H1032	032	0	1	01	01	H1032_032_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	032	0	1	01	01	H1032_032_0	4	Generic	4	11	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		50.00				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		150.00				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					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	040	0	1	01	01	H1032_040_0	4	Generic	4	11	3	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	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		50.00				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	4	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		100.00				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	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												
H1032	061	0	1	01	01	H1032_061_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	4	Generic	3	11	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		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_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		94.00				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	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.92	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	4	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												
H1032	073	0	1	01	01	H1032_073_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	073	0	1	01	01	H1032_073_0	4	Generic	4	11	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		0.00				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	4	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		70.00				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	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				66.01	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	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												
H1032	079	0	1	02	01	H1032_079_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	079	0	1	02	01	H1032_079_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	079	0	1	02	01	H1032_079_0	4	Generic	4	11	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		0.00				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	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		80.00				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	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				66.72	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	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												
H1032	091	0	1	02	01	H1032_091_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	091	0	1	02	01	H1032_091_0	4	Generic	4	11	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	4	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		70.00				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	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		150.00				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	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												
H1032	124	0	1	01	01	H1032_124_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5	Generic	3	11	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		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5	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												
H1032	124	0	1	01	01	H1032_124_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.79	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	5	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												
H1032	133	0	1	02	01	H1032_133_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	133	0	1	02	01	H1032_133_0	4	Generic	4	11	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		0.00				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		90.00				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				64.65	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					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	4	Generic	3	11	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		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_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		94.00				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	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.82	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	4	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												
H1032	174	0	1	02	01	H1032_174_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	174	0	1	02	01	H1032_174_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	174	0	1	02	01	H1032_174_0	4	Generic	4	11	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	4	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		30.00				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	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		150.00				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	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												
H1032	175	0	1	01	01	H1032_175_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5	Generic	3	11	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		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5	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												
H1032	175	0	1	01	01	H1032_175_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.99	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	5	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												
H1032	176	0	1	01	01	H1032_176_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	4	Generic	3	11	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		0.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.00	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	4	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												
H1032	182	0	1	01	01	H1032_182_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	4	Generic	3	11	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		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_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																									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												
H1032	182	0	1	01	01	H1032_182_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.74	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	4	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												
H1032	184	0	1	01	01	H1032_184_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	184	0	1	01	01	H1032_184_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	184	0	1	01	01	H1032_184_0	5	Generic	4	11	3	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	5	Generic	4	11	3	2	2	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		3
H1032	184	0	1	01	01	H1032_184_0	5	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		30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	184	0	1	01	01	H1032_184_0	5	Preferred Brand	4	11	1	2	3	3	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		0.00				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
H1032	184	0	1	01	01	H1032_184_0	5	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		150.00				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	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												
H1032	186	0	1	01	01	H1032_186_0	6	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	186	0	1	01	01	H1032_186_0	6	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	186	0	1	01	01	H1032_186_0	6	Generic	4	11	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	6	Generic	4	11	1	2	2	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		
H1032	186	0	1	01	01	H1032_186_0	6	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		30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	186	0	1	01	01	H1032_186_0	6	Preferred Brand	4	11	1	2	3	3	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		0.00				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
H1032	186	0	1	01	01	H1032_186_0	6	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		100.00				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	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												
H1032	187	1	1	01	01	H1032_187_1	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	187	1	1	01	01	H1032_187_1	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	187	1	1	01	01	H1032_187_1	4	Generic	4	11	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	4	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		70.00				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	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		150.00				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	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												
H1032	187	2	1	01	01	H1032_187_2	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	187	2	1	01	01	H1032_187_2	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	187	2	1	01	01	H1032_187_2	4	Generic	4	11	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	4	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		70.00				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	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		150.00				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	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												
H1032	188	1	1	01	01	H1032_188_1	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	188	1	1	01	01	H1032_188_1	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	188	1	1	01	01	H1032_188_1	4	Generic	4	11	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		0.00				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	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		90.00				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	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				63.41	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	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												
H1032	188	2	1	01	01	H1032_188_2	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	188	2	1	01	01	H1032_188_2	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	188	2	1	01	01	H1032_188_2	4	Generic	4	11	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		0.00				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	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		90.00				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	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				63.41	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	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												
H1032	189	0	1	01	01	H1032_189_0	6	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	189	0	1	01	01	H1032_189_0	6	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	189	0	1	01	01	H1032_189_0	6	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	189	0	1	01	01	H1032_189_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												
H1032	189	0	1	01	01	H1032_189_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				68.11	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	189	0	1	01	01	H1032_189_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												
H1032	190	0	1	01	01	H1032_190_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	190	0	1	01	01	H1032_190_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	190	0	1	01	01	H1032_190_0	5	Generic	4	11	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		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	190	0	1	01	01	H1032_190_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																									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												
H1032	190	0	1	01	01	H1032_190_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				66.43	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	190	0	1	01	01	H1032_190_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												
H1032	191	0	1	01	01	H1032_191_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	191	0	1	01	01	H1032_191_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	191	0	1	01	01	H1032_191_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	191	0	1	01	01	H1032_191_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	191	0	1	01	01	H1032_191_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		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	191	0	1	01	01	H1032_191_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												
H1032	192	0	1	01	01	H1032_192_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	192	0	1	01	01	H1032_192_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	192	0	1	01	01	H1032_192_0	5	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	192	0	1	01	01	H1032_192_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																									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												
H1032	192	0	1	01	01	H1032_192_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				66.43	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	192	0	1	01	01	H1032_192_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												
H1032	193	0	1	01	01	H1032_193_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	193	0	1	01	01	H1032_193_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	193	0	1	01	01	H1032_193_0	4	Generic	4	11	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		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	193	0	1	01	01	H1032_193_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		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	193	0	1	01	01	H1032_193_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		270.00				90.00		180.00				90.00				90.00		3.00				3.00	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	193	0	1	01	01	H1032_193_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												
H1032	194	0	1	01	01	H1032_194_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	194	0	1	01	01	H1032_194_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	194	0	1	01	01	H1032_194_0	5	Generic	4	11	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	194	0	1	01	01	H1032_194_0	5	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		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	194	0	1	01	01	H1032_194_0	5	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		150.00				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	194	0	1	01	01	H1032_194_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												
H1032	195	0	1	01	01	H1032_195_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	195	0	1	01	01	H1032_195_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	195	0	1	01	01	H1032_195_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	195	0	1	01	01	H1032_195_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		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	195	0	1	01	01	H1032_195_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		270.00				90.00		180.00				90.00				90.00		3.00				3.00	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	195	0	1	01	01	H1032_195_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												
H1032	196	0	1	01	01	H1032_196_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	196	0	1	01	01	H1032_196_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	196	0	1	01	01	H1032_196_0	5	Generic	4	11	3	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	196	0	1	01	01	H1032_196_0	5	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		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	196	0	1	01	01	H1032_196_0	5	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		150.00				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	196	0	1	01	01	H1032_196_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												
H1032	197	0	1	01	01	H1032_197_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	197	0	1	01	01	H1032_197_0	5	Generic	4	11	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	197	0	1	01	01	H1032_197_0	5	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												
H1032	197	0	1	01	01	H1032_197_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.38	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	197	0	1	01	01	H1032_197_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												
H1032	198	0	1	01	01	H1032_198_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	198	0	1	01	01	H1032_198_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	198	0	1	01	01	H1032_198_0	5	Generic	4	11	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	198	0	1	01	01	H1032_198_0	5	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		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	198	0	1	01	01	H1032_198_0	5	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		180.00				90.00				90.00		3.00				3.00	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	198	0	1	01	01	H1032_198_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												
H1032	199	0	1	01	01	H1032_199_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	199	0	1	01	01	H1032_199_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	199	0	1	01	01	H1032_199_0	5	Generic	4	11	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	199	0	1	01	01	H1032_199_0	5	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		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	199	0	1	01	01	H1032_199_0	5	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		150.00				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	199	0	1	01	01	H1032_199_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												
H1032	200	0	1	01	01	H1032_200_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	200	0	1	01	01	H1032_200_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	200	0	1	01	01	H1032_200_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	200	0	1	01	01	H1032_200_0	4	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		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	200	0	1	01	01	H1032_200_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	200	0	1	01	01	H1032_200_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												
H1032	201	0	1	01	01	H1032_201_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	201	0	1	01	01	H1032_201_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	201	0	1	01	01	H1032_201_0	5	Generic	4	11	3	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	201	0	1	01	01	H1032_201_0	5	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		30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	201	0	1	01	01	H1032_201_0	5	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		150.00				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	201	0	1	01	01	H1032_201_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												
H1032	202	0	1	01	01	H1032_202_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	202	0	1	01	01	H1032_202_0	5	Generic	4	11	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	202	0	1	01	01	H1032_202_0	5	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												
H1032	202	0	1	01	01	H1032_202_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.38	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	202	0	1	01	01	H1032_202_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												
H1032	203	0	1	01	01	H1032_203_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	203	0	1	01	01	H1032_203_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	203	0	1	01	01	H1032_203_0	5	Generic	4	11	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		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	203	0	1	01	01	H1032_203_0	5	Generic	4	11	1	2	2	3	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										1		
H1032	203	0	1	01	01	H1032_203_0	5	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		30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	203	0	1	01	01	H1032_203_0	5	Preferred Brand	4	11	1	2	3	3	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										2	1	
H1032	203	0	1	01	01	H1032_203_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	203	0	1	01	01	H1032_203_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												
H1032	204	0	1	01	01	H1032_204_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	204	0	1	01	01	H1032_204_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	204	0	1	01	01	H1032_204_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	204	0	1	01	01	H1032_204_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		90.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	204	0	1	01	01	H1032_204_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				68.11	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	204	0	1	01	01	H1032_204_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												
H1032	205	0	1	01	01	H1032_205_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	205	0	1	01	01	H1032_205_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	205	0	1	01	01	H1032_205_0	5	Generic	4	11	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	205	0	1	01	01	H1032_205_0	5	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		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	205	0	1	01	01	H1032_205_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				65.05	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	205	0	1	01	01	H1032_205_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												
H1032	206	0	1	01	01	H1032_206_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	206	0	1	01	01	H1032_206_0	5	Generic	3	11	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		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	206	0	1	01	01	H1032_206_0	5	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												
H1032	206	0	1	01	01	H1032_206_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.38	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	206	0	1	01	01	H1032_206_0	5	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												
H1032	209	0	1	01	01	H1032_209_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	209	0	1	01	01	H1032_209_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	209	0	1	01	01	H1032_209_0	4	Generic	4	11	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		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	209	0	1	01	01	H1032_209_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		90.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	209	0	1	01	01	H1032_209_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				68.10	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	209	0	1	01	01	H1032_209_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												
H1032	210	0	1	01	01	H1032_210_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	210	0	1	01	01	H1032_210_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	210	0	1	01	01	H1032_210_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	210	0	1	01	01	H1032_210_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		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	210	0	1	01	01	H1032_210_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		270.00				90.00		180.00				90.00				90.00		3.00				3.00	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	210	0	1	01	01	H1032_210_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												
H1032	211	0	1	01	01	H1032_211_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	211	0	1	01	01	H1032_211_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	211	0	1	01	01	H1032_211_0	5	Generic	4	11	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	211	0	1	01	01	H1032_211_0	5	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		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	211	0	1	01	01	H1032_211_0	5	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		150.00				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	211	0	1	01	01	H1032_211_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												
H1032	212	0	1	01	01	H1032_212_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	212	0	1	01	01	H1032_212_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	212	0	1	01	01	H1032_212_0	4	Generic	4	11	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		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	212	0	1	01	01	H1032_212_0	4	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		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	212	0	1	01	01	H1032_212_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		285.00				95.00		190.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	212	0	1	01	01	H1032_212_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												
H1032	213	0	1	01	01	H1032_213_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	213	0	1	01	01	H1032_213_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	213	0	1	01	01	H1032_213_0	5	Generic	4	11	3	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	213	0	1	01	01	H1032_213_0	5	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		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	213	0	1	01	01	H1032_213_0	5	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		150.00				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	213	0	1	01	01	H1032_213_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												
H1032	214	0	1	01	01	H1032_214_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	214	0	1	01	01	H1032_214_0	5	Generic	3	11	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		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	214	0	1	01	01	H1032_214_0	5	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												
H1032	214	0	1	01	01	H1032_214_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.38	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	214	0	1	01	01	H1032_214_0	5	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												
H1032	215	0	1	01	01	H1032_215_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	215	0	1	01	01	H1032_215_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	215	0	1	01	01	H1032_215_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	215	0	1	01	01	H1032_215_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		90.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	215	0	1	01	01	H1032_215_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		285.00				95.00		190.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	215	0	1	01	01	H1032_215_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												
H1032	216	0	1	01	01	H1032_216_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	216	0	1	01	01	H1032_216_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	216	0	1	01	01	H1032_216_0	5	Generic	4	11	3	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	216	0	1	01	01	H1032_216_0	5	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		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	216	0	1	01	01	H1032_216_0	5	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		150.00				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	216	0	1	01	01	H1032_216_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												
H1032	217	0	1	01	01	H1032_217_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	217	0	1	01	01	H1032_217_0	5	Generic	3	11	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		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	217	0	1	01	01	H1032_217_0	5	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												
H1032	217	0	1	01	01	H1032_217_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.38	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	217	0	1	01	01	H1032_217_0	5	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												
H1032	218	0	1	01	01	H1032_218_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	218	0	1	01	01	H1032_218_0	5	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1032	218	0	1	01	01	H1032_218_0	5	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	218	0	1	01	01	H1032_218_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																									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												
H1032	218	0	1	01	01	H1032_218_0	5	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		198.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	218	0	1	01	01	H1032_218_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												
H1035	002	0	1	02	01	H1035_002_0	8	Preferred Generic	4	01	1	2	1	1		111	01	100		1				31	62	93	2	1			93				31		31								17.00	34.00	51.00					0.00	0.00	0.00							0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	8	Preferred Generic	4	01	1	2	1	3		111	01	100		1				31	62	93	2	1			93				31		31								17.00	34.00	51.00					0.00	0.00	0.00							0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	002	0	1	02	01	H1035_002_0	8	Generic	4	01	1	2	2	1		111	01	100		1				31	62	93	2	1			93				31		31								20.00	40.00	60.00					4.00	8.00	12.00							9.00																20.00				20.00			0.65	0.13				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	8	Generic	4	01	1	2	2	3		111	01	100		1				31	62	93	2	1			93				31		31								20.00	40.00	60.00					4.00	8.00	12.00							9.00																20.00				20.00			0.65	0.13				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	002	0	1	02	01	H1035_002_0	8	Preferred Brand	4	10	1	2	3	1		111	01	100		1				31	62	93	2	1			93				31		31								47.00	94.00	141.00					42.00	84.00	126.00							123.00																47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	8	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				31	62	93	2	1			93				31		31								100.00	200.00	300.00					92.00	184.00	276.00							273.00																100.00				100.00			3.23	2.97				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											697.78	33						437.25	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	7	Preferred Generic	4	01	1	2	1	1		111	01	100		1				31	62	93	2	1			93				31		31								17.00	34.00	51.00					2.00	4.00	6.00							3.00																17.00				17.00			0.55	0.06				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	7	Generic	4	01	1	2	2	1		111	01	100		1				31	62	93	2	1			93				31		31								20.00	40.00	60.00					7.00	14.00	21.00							18.00																20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	7	Preferred Brand	4	10	1	2	3	1		111	01	100		1				31	62	93	2	1			93				31		31								47.00	94.00	141.00					44.00	88.00	132.00							129.00																47.00				47.00			1.52	1.42				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				31	62	93	2	1			93				31		31								100.00	200.00	300.00					95.00	190.00	285.00							282.00																100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	7	Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											712.12	26						306.62	26																							26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	011	0	1	01	01	H1035_011_0	7	Preferred Generic	4	01	1	2	1	1		111	01	100		1				31	62	93	2	1			93				31		31								17.00	34.00	51.00					0.00	0.00	0.00							0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	011	0	1	01	01	H1035_011_0	7	Preferred Generic	4	01	1	2	1	3		111	01	100		1				31	62	93	2	1			93				31		31								17.00	34.00	51.00					0.00	0.00	0.00							0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	011	0	1	01	01	H1035_011_0	7	Generic	4	01	1	2	2	1		111	01	100		1				31	62	93	2	1			93				31		31								20.00	40.00	60.00					7.00	14.00	21.00							18.00																20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	011	0	1	01	01	H1035_011_0	7	Generic	4	01	1	2	2	3		111	01	100		1				31	62	93	2	1			93				31		31								20.00	40.00	60.00					7.00	14.00	21.00							18.00																20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	011	0	1	01	01	H1035_011_0	7	Preferred Brand	4	10	1	2	3	1		111	01	100		1				31	62	93	2	1			93				31		31								47.00	94.00	141.00					44.00	88.00	132.00							129.00																47.00				47.00			1.52	1.42				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	011	0	1	01	01	H1035_011_0	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				31	62	93	2	1			93				31		31								100.00	200.00	300.00					95.00	190.00	285.00							282.00																100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	011	0	1	01	01	H1035_011_0	7	Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											938.83	33						488.94	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	014	0	1	01	01	H1035_014_0	7	Preferred Generic	4	01	1	2	1	1		111	01	100		1				31	62	93	2	1			93				31		31								17.00	34.00	51.00					4.00	8.00	12.00							9.00																17.00				17.00			0.55	0.13				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	014	0	1	01	01	H1035_014_0	7	Generic	4	01	1	2	2	1		111	01	100		1				31	62	93	2	1			93				31		31								20.00	40.00	60.00					10.00	20.00	30.00							27.00																20.00				20.00			0.65	0.32				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	014	0	1	01	01	H1035_014_0	7	Preferred Brand	4	10	1	2	3	1		111	01	100		1				31	62	93	2	1			93				31		31								47.00	94.00	141.00					45.00	90.00	135.00							132.00																47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	014	0	1	01	01	H1035_014_0	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				31	62	93	2	1			93				31		31								100.00	200.00	300.00					98.00	196.00	294.00							291.00																100.00				100.00			3.23	3.16				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	014	0	1	01	01	H1035_014_0	7	Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											667.80	25						284.48	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	016	0	1	01	01	H1035_016_0	7	Preferred Generic	4	01	1	2	1	1		111	01	100		1				31	62	93	2	1			93				31		31								13.00	26.00	39.00					0.00	0.00	0.00							0.00																13.00				13.00			0.42	0.00				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	016	0	1	01	01	H1035_016_0	7	Preferred Generic	4	01	1	2	1	3		111	01	100		1				31	62	93	2	1			93				31		31								13.00	26.00	39.00					0.00	0.00	0.00							0.00																13.00				13.00			0.42	0.00				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	016	0	1	01	01	H1035_016_0	7	Generic	4	01	1	2	2	1		111	01	100		1				31	62	93	2	1			93				31		31								20.00	40.00	60.00					10.00	20.00	30.00							27.00																20.00				20.00			0.65	0.32				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	016	0	1	01	01	H1035_016_0	7	Generic	4	01	1	2	2	3		111	01	100		1				31	62	93	2	1			93				31		31								20.00	40.00	60.00					10.00	20.00	30.00							27.00																20.00				20.00			0.65	0.32				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	016	0	1	01	01	H1035_016_0	7	Preferred Brand	4	10	1	2	3	1		111	01	100		1				31	62	93	2	1			93				31		31								47.00	94.00	141.00					45.00	90.00	135.00							132.00																47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	016	0	1	01	01	H1035_016_0	7	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				31	62	93	2	1			93				31		31								100.00	200.00	300.00					98.00	196.00	294.00							291.00																100.00				100.00			3.23	3.16				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	016	0	1	01	01	H1035_016_0	7	Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											942.77	33						446.16	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	017	0	1	01	01	H1035_017_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												
H1035	017	0	1	01	01	H1035_017_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		
H1035	017	0	1	01	01	H1035_017_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					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1035	017	0	1	01	01	H1035_017_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					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1035	017	0	1	01	01	H1035_017_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												
H1035	017	0	1	01	01	H1035_017_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												
H1035	017	0	1	01	01	H1035_017_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												
H1035	017	0	1	01	01	H1035_017_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												
H1035	017	0	1	01	01	H1035_017_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		
H1035	018	0	1	01	01	H1035_018_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												
H1035	018	0	1	01	01	H1035_018_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		
H1035	018	0	1	01	01	H1035_018_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					3.00		9.00					3.00		9.00																15.00				3.00			0.48	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1035	018	0	1	01	01	H1035_018_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					3.00		9.00					3.00		9.00																15.00				3.00			0.48	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1035	018	0	1	01	01	H1035_018_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					35.00		105.00					35.00		105.00																47.00				35.00			1.52	1.13	1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1035	018	0	1	01	01	H1035_018_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												
H1035	018	0	1	01	01	H1035_018_0	10	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												
H1035	018	0	1	01	01	H1035_018_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												
H1035	018	0	1	01	01	H1035_018_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		
H1035	019	0	1	01	01	H1035_019_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					3.00		9.00					3.00		9.00																10.00				3.00			0.32	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	019	0	1	01	01	H1035_019_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					3.00		9.00					3.00		9.00																10.00				3.00			0.32	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	019	0	1	01	01	H1035_019_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					10.00		30.00					10.00		30.00																15.00				10.00			0.48	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	019	0	1	01	01	H1035_019_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 Drug, Specialty Tier, Select Care Drugs												
H1035	019	0	1	01	01	H1035_019_0	10	Non-Preferred Drug	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 Drug, Specialty Tier, Select Care Drugs												
H1035	019	0	1	01	01	H1035_019_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H1035	019	0	1	01	01	H1035_019_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 Drug, Specialty Tier, Select Care Drugs												
H1035	019	0	1	01	01	H1035_019_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 Drug, Specialty Tier, Select Care Drugs										1		
H1035	020	0	1	01	01	H1035_020_0	10	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	020	0	1	01	01	H1035_020_0	10	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	020	0	1	01	01	H1035_020_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H1035	020	0	1	01	01	H1035_020_0	10	Generic	4	01	1	2	2	3		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 Drug, Specialty Tier, Select Care Drugs										1		
H1035	020	0	1	01	01	H1035_020_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 Drug, Specialty Tier, Select Care Drugs												
H1035	020	0	1	01	01	H1035_020_0	10	Non-Preferred Drug	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 Drug, Specialty Tier, Select Care Drugs												
H1035	020	0	1	01	01	H1035_020_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H1035	020	0	1	01	01	H1035_020_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 Drug, Specialty Tier, Select Care Drugs												
H1035	020	0	1	01	01	H1035_020_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 Drug, Specialty Tier, Select Care Drugs										1		
H1035	021	0	1	01	01	H1035_021_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H1035	021	0	1	01	01	H1035_021_0	10	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 Drug, Specialty Tier, Select Care Drugs										1		
H1035	021	0	1	01	01	H1035_021_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H1035	021	0	1	01	01	H1035_021_0	10	Generic	4	01	1	2	2	3		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 Drug, Specialty Tier, Select Care Drugs										1		
H1035	021	0	1	01	01	H1035_021_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 Drug, Specialty Tier, Select Care Drugs												
H1035	021	0	1	01	01	H1035_021_0	10	Non-Preferred Drug	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 Drug, Specialty Tier, Select Care Drugs												
H1035	021	0	1	01	01	H1035_021_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H1035	021	0	1	01	01	H1035_021_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 Drug, Specialty Tier, Select Care Drugs												
H1035	021	0	1	01	01	H1035_021_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 Drug, Specialty Tier, Select Care Drugs										1		
H1035	022	0	1	01	01	H1035_022_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												
H1035	022	0	1	01	01	H1035_022_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		
H1035	022	0	1	01	01	H1035_022_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					3.00		9.00					3.00		9.00																15.00				3.00			0.48	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1035	022	0	1	01	01	H1035_022_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					3.00		9.00					3.00		9.00																15.00				3.00			0.48	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1035	022	0	1	01	01	H1035_022_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					35.00		105.00					35.00		105.00																47.00				35.00			1.52	1.13	1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1035	022	0	1	01	01	H1035_022_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												
H1035	022	0	1	01	01	H1035_022_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												
H1035	022	0	1	01	01	H1035_022_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												
H1035	022	0	1	01	01	H1035_022_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		
H1035	023	0	1	01	01	H1035_023_0	9	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												
H1035	023	0	1	01	01	H1035_023_0	9	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		
H1035	023	0	1	01	01	H1035_023_0	9	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												
H1035	023	0	1	01	01	H1035_023_0	9	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		
H1035	023	0	1	01	01	H1035_023_0	9	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					25.00		75.00					25.00		75.00																45.00				25.00			1.45	0.81	0.81			0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1035	023	0	1	01	01	H1035_023_0	9	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												
H1035	023	0	1	01	01	H1035_023_0	9	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												
H1035	023	0	1	01	01	H1035_023_0	9	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												
H1035	023	0	1	01	01	H1035_023_0	9	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
H1035	024	0	1	01	01	H1035_024_0	9	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												
H1035	024	0	1	01	01	H1035_024_0	9	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		
H1035	024	0	1	01	01	H1035_024_0	9	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												
H1035	024	0	1	01	01	H1035_024_0	9	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		
H1035	024	0	1	01	01	H1035_024_0	9	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												
H1035	024	0	1	01	01	H1035_024_0	9	Preferred Brand	4	11	1	2	3	3		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										1		
H1035	024	0	1	01	01	H1035_024_0	9	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					50.00		150.00					50.00		150.00																75.00				50.00			2.42	1.61	1.61			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1035	024	0	1	01	01	H1035_024_0	9	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												
H1035	024	0	1	01	01	H1035_024_0	9	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												
H1035	024	0	1	01	01	H1035_024_0	9	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
H1035	025	0	1	01	01	H1035_025_0	9	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												
H1035	025	0	1	01	01	H1035_025_0	9	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		
H1035	025	0	1	01	01	H1035_025_0	9	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												
H1035	025	0	1	01	01	H1035_025_0	9	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		
H1035	025	0	1	01	01	H1035_025_0	9	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					20.00		60.00					20.00		60.00																45.00				20.00			1.45	0.65	0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1035	025	0	1	01	01	H1035_025_0	9	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												
H1035	025	0	1	01	01	H1035_025_0	9	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												
H1035	025	0	1	01	01	H1035_025_0	9	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												
H1035	025	0	1	01	01	H1035_025_0	9	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
H1035	026	0	1	01	01	H1035_026_0	9	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												
H1035	026	0	1	01	01	H1035_026_0	9	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		
H1035	026	0	1	01	01	H1035_026_0	9	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												
H1035	026	0	1	01	01	H1035_026_0	9	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		
H1035	026	0	1	01	01	H1035_026_0	9	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												
H1035	026	0	1	01	01	H1035_026_0	9	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												
H1035	026	0	1	01	01	H1035_026_0	9	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												
H1035	026	0	1	01	01	H1035_026_0	9	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												
H1035	026	0	1	01	01	H1035_026_0	9	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
H1035	027	0	1	01	01	H1035_027_0	10	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												
H1035	027	0	1	01	01	H1035_027_0	10	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		
H1035	027	0	1	01	01	H1035_027_0	10	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												
H1035	027	0	1	01	01	H1035_027_0	10	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		
H1035	027	0	1	01	01	H1035_027_0	10	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												
H1035	027	0	1	01	01	H1035_027_0	10	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	31		90				1	1	31		90				31		31	99.00		297.00																			99.00		297.00																99.00				99.00		3.19			3.19			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H1035	027	0	1	01	01	H1035_027_0	10	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												
H1035	027	0	1	01	01	H1035_027_0	10	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												
H1035	027	0	1	01	01	H1035_027_0	10	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		
H1035	028	0	1	01	01	H1035_028_0	10	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												
H1035	028	0	1	01	01	H1035_028_0	10	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		
H1035	028	0	1	01	01	H1035_028_0	10	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												
H1035	028	0	1	01	01	H1035_028_0	10	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		
H1035	028	0	1	01	01	H1035_028_0	10	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												
H1035	028	0	1	01	01	H1035_028_0	10	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	31		90				1	1	31		90				31		31	99.00		297.00																			99.00		297.00																99.00				99.00		3.19			3.19			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H1035	028	0	1	01	01	H1035_028_0	10	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												
H1035	028	0	1	01	01	H1035_028_0	10	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												
H1035	028	0	1	01	01	H1035_028_0	10	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		
H1035	029	0	1	01	01	H1035_029_0	10	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												
H1035	029	0	1	01	01	H1035_029_0	10	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		
H1035	029	0	1	01	01	H1035_029_0	10	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												
H1035	029	0	1	01	01	H1035_029_0	10	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		
H1035	029	0	1	01	01	H1035_029_0	10	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												
H1035	029	0	1	01	01	H1035_029_0	10	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	31		90				1	1	31		90				31		31	99.00		297.00																			99.00		297.00																99.00				99.00		3.19			3.19			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H1035	029	0	1	01	01	H1035_029_0	10	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												
H1035	029	0	1	01	01	H1035_029_0	10	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												
H1035	029	0	1	01	01	H1035_029_0	10	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		
H1035	030	0	1	01	01	H1035_030_0	10	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												
H1035	030	0	1	01	01	H1035_030_0	10	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		
H1035	030	0	1	01	01	H1035_030_0	10	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												
H1035	030	0	1	01	01	H1035_030_0	10	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		
H1035	030	0	1	01	01	H1035_030_0	10	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												
H1035	030	0	1	01	01	H1035_030_0	10	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	31		90				1	1	31		90				31		31	99.00		297.00																			99.00		297.00																99.00				99.00		3.19			3.19			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H1035	030	0	1	01	01	H1035_030_0	10	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												
H1035	030	0	1	01	01	H1035_030_0	10	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												
H1035	030	0	1	01	01	H1035_030_0	10	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		
H1036	025	0	1	01	01	H1036_025_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H1036	025	0	1	01	01	H1036_025_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	025	0	1	01	01	H1036_025_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					5.00		15.00											47.00		141.00				5.00		5.00				47.00				47.00			1.57	0.17		1.57	0.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_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	044	0	1	01	01	H1036_044_0	5	Preferred Generic	4	11	3	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	5	Preferred Generic	4	11	3	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		3
H1036	044	0	1	01	01	H1036_044_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	044	0	1	01	01	H1036_044_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	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 Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	4	Preferred Generic	4	11	3	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	3	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		3
H1036	054	0	1	01	01	H1036_054_0	4	Generic	4	11	1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	4	Generic	4	11	1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
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	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	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	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H1036	062	0	1	01	01	H1036_062_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					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	062	0	1	01	01	H1036_062_0	4	Generic	4	11	1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	062	0	1	01	01	H1036_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_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												
H1036	065	0	1	01	01	H1036_065_0	5	Preferred Generic	4	11	3	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	5	Preferred Generic	4	11	3	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		3
H1036	065	0	1	01	01	H1036_065_0	5	Generic	4	11	1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5	Generic	4	11	1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	065	0	1	01	01	H1036_065_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	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 Drug, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H1036	067	0	1	01	01	H1036_067_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	067	0	1	01	01	H1036_067_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					5.00		15.00											47.00		141.00				5.00		5.00				47.00				47.00			1.57	0.17		1.57	0.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_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	068	0	1	01	01	H1036_068_0	5	Preferred Generic	4	11	3	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	5	Preferred Generic	4	11	3	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		3
H1036	068	0	1	01	01	H1036_068_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	068	0	1	01	01	H1036_068_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	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 Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H1036	074	0	1	01	01	H1036_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	074	0	1	01	01	H1036_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_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					60.00		180.00											100.00		300.00				60.00		170.00				100.00				100.00			3.33	2		3.33	2	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_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												
H1036	077	0	1	01	01	H1036_077_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_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	081	0	1	01	01	H1036_081_0	5	Preferred Generic	4	11	3	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	5	Preferred Generic	4	11	3	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		3
H1036	081	0	1	01	01	H1036_081_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	081	0	1	01	01	H1036_081_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	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 Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_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	103	0	1	01	01	H1036_103_0	4	Preferred Generic	4	11	3	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	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	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	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	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	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_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	121	0	1	01	01	H1036_121_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H1036	121	0	1	01	01	H1036_121_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					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												
H1036	121	0	1	01	01	H1036_121_0	4	Generic	4	11	1	2	2	3		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	121	0	1	01	01	H1036_121_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_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	130	0	1	01	01	H1036_130_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H1036	130	0	1	01	01	H1036_130_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	4	Generic	4	11	1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	130	0	1	01	01	H1036_130_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_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												
H1036	137	0	1	01	01	H1036_137_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												
H1036	137	0	1	01	01	H1036_137_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	5	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	140	0	1	01	01	H1036_140_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H1036	140	0	1	01	01	H1036_140_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	140	0	1	01	01	H1036_140_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_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	143	0	1	01	01	H1036_143_0	5	Preferred Generic	4	11	3	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	5	Preferred Generic	4	11	3	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	3
H1036	143	0	1	01	01	H1036_143_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H1036	143	0	1	01	01	H1036_143_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_0	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 Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	5	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												17							17												17						17					17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	146	0	1	01	01	H1036_146_0	5	Preferred Generic	4	11	3	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	5	Preferred Generic	4	11	3	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		3
H1036	146	0	1	01	01	H1036_146_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	146	0	1	01	01	H1036_146_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	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 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	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	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	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	4	Preferred Generic	4	11	3	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	153	0	1	01	01	H1036_153_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_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												
H1036	156	0	1	01	01	H1036_156_0	5	Preferred Generic	4	11	3	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	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 Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	5	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	5	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	157	0	1	01	01	H1036_157_0	5	Preferred Generic	4	11	3	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	157	0	1	01	01	H1036_157_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	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 Drug, Specialty Tier												
H1036	160	0	1	01	01	H1036_160_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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	3
H1036	160	0	1	01	01	H1036_160_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	4	Preferred Brand	4	11	1	2	3	3		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1036	160	0	1	01	01	H1036_160_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					60.00		180.00											100.00		300.00				60.00		170.00				100.00				100.00			3.33	2		3.33	2	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_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	160	0	1	01	01	H1036_160_0	4	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												17							17												17						17					17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_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	160	0	1	01	01	H1036_160_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	167	0	1	01	01	H1036_167_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	167	0	1	01	01	H1036_167_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_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	168	0	1	01	01	H1036_168_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	168	0	1	01	01	H1036_168_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	5	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	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	171	0	1	01	01	H1036_171_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_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												
H1036	175	0	1	01	01	H1036_175_0	5	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	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 Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	5	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	5	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	5	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	5	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	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_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	210	0	1	01	01	H1036_210_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_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												
H1036	213	0	1	01	01	H1036_213_0	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_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	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	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	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	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	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H1036	215	0	1	01	01	H1036_215_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	215	0	1	01	01	H1036_215_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_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	217	0	1	01	01	H1036_217_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H1036	217	0	1	01	01	H1036_217_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	4	Generic	4	11	1	2	2	3		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	217	0	1	01	01	H1036_217_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_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	219	0	1	01	01	H1036_219_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_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												
H1036	222	0	1	01	01	H1036_222_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	222	0	1	01	01	H1036_222_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_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	223	0	1	01	01	H1036_223_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	223	0	1	01	01	H1036_223_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	5	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	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_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												
H1036	229	0	1	01	01	H1036_229_0	4	Preferred Generic	4	11	3	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	229	0	1	01	01	H1036_229_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_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					30.00		90.00											47.00		141.00				30.00		80.00				47.00				47.00			1.57	1		1.57	1	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_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	230	0	1	01	01	H1036_230_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_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	231	0	1	01	01	H1036_231_0	3	Preferred Generic	4	11	3	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	3	Generic	4	11	1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_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												
H1036	233	0	1	01	01	H1036_233_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	233	0	1	01	01	H1036_233_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_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												
H1036	234	0	1	01	01	H1036_234_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	234	0	1	01	01	H1036_234_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_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	234	0	1	01	01	H1036_234_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	235	0	1	01	01	H1036_235_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												
H1036	235	0	1	01	01	H1036_235_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_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												
H1036	236	0	1	01	01	H1036_236_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	236	0	1	01	01	H1036_236_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_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	237	1	1	01	01	H1036_237_1	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	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	237	2	1	01	01	H1036_237_2	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	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	241	0	1	01	01	H1036_241_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	241	0	1	01	01	H1036_241_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	241	0	1	01	01	H1036_241_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	241	0	1	01	01	H1036_241_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	243	0	1	01	01	H1036_243_0	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_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	245	0	1	01	01	H1036_245_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	245	0	1	01	01	H1036_245_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_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												
H1036	247	0	1	01	01	H1036_247_0	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_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	249	0	1	01	01	H1036_249_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_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	251	0	1	01	01	H1036_251_0	3	Preferred Generic	4	11	3	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	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	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	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	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	3	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	1	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	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	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	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												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	255	0	1	01	01	H1036_255_0	3	Preferred Generic	4	11	3	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	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	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	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	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	3	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	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	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	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	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	3	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	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	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	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	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_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	262	0	1	01	01	H1036_262_0	3	Preferred Generic	4	11	3	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	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	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	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	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	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												
H1036	263	0	1	01	01	H1036_263_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	263	0	1	01	01	H1036_263_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	263	0	1	01	01	H1036_263_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	263	0	1	01	01	H1036_263_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												
H1036	264	0	1	01	01	H1036_264_0	3	Preferred Generic	4	11	3	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	264	0	1	01	01	H1036_264_0	3	Generic	4	11	1	1	2	1		110	01		110	1				30		90	2	2				30		90	30		31											5.00	25		25				5.00	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	3	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	25		25				31.00	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	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											50.00	25		25				48.00	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	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	265	1	1	01	01	H1036_265_1	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	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	265	2	1	01	01	H1036_265_2	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	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	266	0	1	01	01	H1036_266_0	4	Preferred Generic	4	11	3	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	4	Generic	4	11	1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_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	267	0	1	01	01	H1036_267_0	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	267	0	1	01	01	H1036_267_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	267	0	1	01	01	H1036_267_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	267	0	1	01	01	H1036_267_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	268	0	1	01	01	H1036_268_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_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	269	0	1	01	01	H1036_269_0	5	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	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 Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	5	Preferred Generic	4	11	3	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	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 Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	5	Preferred Generic	4	11	3	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_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												
H1036	275	1	1	01	01	H1036_275_1	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												
H1036	275	1	1	01	01	H1036_275_1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	275	1	1	01	01	H1036_275_1	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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	275	1	1	01	01	H1036_275_1	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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	275	1	1	01	01	H1036_275_1	5	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	275	2	1	01	01	H1036_275_2	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												
H1036	275	2	1	01	01	H1036_275_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	275	2	1	01	01	H1036_275_2	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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	275	2	1	01	01	H1036_275_2	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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	275	2	1	01	01	H1036_275_2	5	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	276	0	1	01	01	H1036_276_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	276	0	1	01	01	H1036_276_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	276	0	1	01	01	H1036_276_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	276	0	1	01	01	H1036_276_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	276	0	1	01	01	H1036_276_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												
H1036	277	0	1	01	01	H1036_277_0	5	Preferred Generic	4	11	3	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	277	0	1	01	01	H1036_277_0	5	Preferred Generic	4	11	3	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		3
H1036	277	0	1	01	01	H1036_277_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	277	0	1	01	01	H1036_277_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	277	0	1	01	01	H1036_277_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	277	0	1	01	01	H1036_277_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					90.00		270.00											100.00		300.00				90.00		260.00				100.00				100.00			3.33	3		3.33	3	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	277	0	1	01	01	H1036_277_0	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 Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	5	Preferred Generic	4	11	3	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	278	0	1	01	01	H1036_278_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	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 Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	001	0	1	01	01	H1045_001_0	2	Generic	4	01	3	2	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	2	Generic	4	01	3	2	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	001	0	1	01	01	H1045_001_0	2	Preferred Brand	4	11	1	2	3	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				684.00	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	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	005	0	1	01	01	H1045_005_0	2	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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												
H1045	005	0	1	01	01	H1045_005_0	2	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										1		3
H1045	005	0	1	01	01	H1045_005_0	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				733.00	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	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	012	0	1	01	01	H1045_012_0	2	Generic	4	01	3	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	2	Generic	4	01	3	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	012	0	1	01	01	H1045_012_0	2	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				42.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				46.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	2	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				632.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	018	0	1	01	01	H1045_018_0	2	Generic	4	01	3	2	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	2	Generic	4	01	3	2	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	018	0	1	01	01	H1045_018_0	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Preferred Brand	4	11	1	2	3	3	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				633.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1433.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				931.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	027	0	1	02	01	H1045_027_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1422.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				885.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	01	01	H1045_030_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1004.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	01	01	H1045_031_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1107.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	01	01	H1045_032_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1138.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1010.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1259.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	01	01	H1045_036_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1045.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	037	0	1	01	01	H1045_037_0	2	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	037	0	1	01	01	H1045_037_0	2	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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		3
H1045	037	0	1	01	01	H1045_037_0	2	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	037	0	1	01	01	H1045_037_0	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				919.00	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				2	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				2	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				2	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				2	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				2	2			90				30		31				45.00	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				2	2			90				30		31				49.00	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				2	2			90				30		31				629.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	01	01	H1045_041_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	01	01	H1045_041_0	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	01	01	H1045_041_0	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	01	01	H1045_041_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	01	01	H1045_041_0	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				993.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	01	01	H1045_042_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1064.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	01	01	H1045_043_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1001.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	01	01	H1045_045_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	045	0	1	01	01	H1045_045_0	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	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	045	0	1	01	01	H1045_045_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	045	0	1	01	01	H1045_045_0	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	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	045	0	1	01	01	H1045_045_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	045	0	1	01	01	H1045_045_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	045	0	1	01	01	H1045_045_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				965.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	4	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	4	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	4	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	4	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	4	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	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																					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	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1187.42	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	4	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	4	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	4	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	4	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	4	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	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																					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	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				975.90	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	4	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	4	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	4	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	4	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	4	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	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																					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	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1126.85	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	4	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	01	01	H1099_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																					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	01	01	H1099_016_0	3	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	01	01	H1099_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																					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	01	01	H1099_016_0	3	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	01	01	H1099_016_0	3	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1340.40	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	01	01	H1099_016_0	3	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	01	01	H1099_016_0	3	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	005	0	1	01	01	H1109_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1109	005	0	1	01	01	H1109_005_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_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	10.00					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		
H1109	005	0	1	01	01	H1109_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	005	0	1	01	01	H1109_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												
H1109	005	0	1	01	01	H1109_005_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												
H1109	006	0	1	01	01	H1109_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	006	0	1	01	01	H1109_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1109	006	0	1	01	01	H1109_006_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	006	0	1	01	01	H1109_006_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	10.00					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		
H1109	006	0	1	01	01	H1109_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	006	0	1	01	01	H1109_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												
H1109	006	0	1	01	01	H1109_006_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												
H1111	006	0	1	01	01	H1111_006_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		7.50																											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				2	2						90	30		31	10.00		25.00																											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				2	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				2	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				2	2						90	30		31				936.00	27		27																										27						27			27			27								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				2	2						90	30		31	3.00		7.50																											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				2	2						90	30		31	10.00		25.00																											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				2	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				2	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				2	2						90	30		31				945.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	5	Generic	3	11	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		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	5	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												
H1112	006	0	1	01	01	H1112_006_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.33	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	5	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												
H1112	033	0	1	01	01	H1112_033_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	033	0	1	01	01	H1112_033_0	5	Generic	3	11	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		0.00				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	5	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												
H1112	033	0	1	01	01	H1112_033_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.93	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	5	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												
H1112	035	0	1	01	01	H1112_035_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	035	0	1	01	01	H1112_035_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H1112	035	0	1	01	01	H1112_035_0	4	Generic	4	11	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		0.00				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	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		94.00				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	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				58.62	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	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												
H1112	036	1	1	01	01	H1112_036_1	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	036	1	1	01	01	H1112_036_1	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H1112	036	1	1	01	01	H1112_036_1	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	036	1	1	01	01	H1112_036_1	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		88.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	036	1	1	01	01	H1112_036_1	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				64.15	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	036	1	1	01	01	H1112_036_1	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												
H1112	036	3	1	01	01	H1112_036_3	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	036	3	1	01	01	H1112_036_3	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H1112	036	3	1	01	01	H1112_036_3	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	036	3	1	01	01	H1112_036_3	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		88.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	036	3	1	01	01	H1112_036_3	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				64.15	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	036	3	1	01	01	H1112_036_3	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												
H1142	001	0	1	01	01	H1142_001_0	9	Preferred Generic	4	11	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			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1142	001	0	1	01	01	H1142_001_0	9	Generic	4	11	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												
H1142	001	0	1	01	01	H1142_001_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				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1142	001	0	1	01	01	H1142_001_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1142	001	0	1	01	01	H1142_001_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				650.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1142	002	0	1	01	01	H1142_002_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1142	002	0	1	01	01	H1142_002_0	9	Generic	4	11	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												
H1142	002	0	1	01	01	H1142_002_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				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1142	002	0	1	01	01	H1142_002_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1142	002	0	1	01	01	H1142_002_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				599.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1170	002	0	1	01	01	H1170_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	0.00	0.00	0.00																			0.00	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												
H1170	002	0	1	01	01	H1170_002_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				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, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	7	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	0.00																8.00				8.00		0.26			0.26			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	7	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	0.00																8.00				8.00		0.26			0.26			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_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		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	7	Non-Preferred Brand	4	10	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		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				2082.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_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												
H1170	002	0	1	01	01	H1170_002_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		
H1170	008	0	1	01	01	H1170_008_0	8	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	0.00																8.00				8.00		0.26			0.26			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	8	Generic	3	11	1	2	2	1	111		01	111		1	30	60	90				2	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, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	8	Preferred Brand	3	10	1	2	3	1	111		01	111		1	30	60	90				2	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 Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	8	Non-Preferred Brand	3	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	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	8	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				1984.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_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												
H1170	009	0	1	01	01	H1170_009_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	0.00																2.00				2.00		0.06			0.06			0.06	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	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	0.00																2.00				2.00		0.06			0.06			0.06	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	111		01	111		1	30	60	90				2	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	0.00																8.00				8.00		0.26			0.26			0.25	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	111		01	111		1	30	60	90				2	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	0.00																8.00				8.00		0.26			0.26			0.25	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	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		1.56			1.56			1.51	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	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		3.16			3.16			3.06	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	111		01	111		1	30	60	90				2	2	30	60	90				30		31				1695.00	33	33	33																		33	33	33															33			33								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	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					0.00																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	9	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					0.00																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	9	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	9	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	9	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	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					0.00																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	9	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					0.00																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	9	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	9	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	9	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	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					0.00																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	8	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					0.00																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	8	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	8	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	8	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	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					0.00																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	8	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					0.00																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	8	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	8	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	8	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	10	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	10	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	10	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	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	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	10	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	10	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	10	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	10	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	10	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	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	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	10	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	10	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	12	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																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	12	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	001	0	1	01	01	H1230_001_0	12	Generic	4	11	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			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	12	Generic	4	11	1	2	2	3	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			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	001	0	1	01	01	H1230_001_0	12	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	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 Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	12	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	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	12	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				1865.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	12	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																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	12	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	12	Generic	4	11	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			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	12	Generic	4	11	1	2	2	3	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			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	12	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	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 Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	12	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	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	12	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				1379.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_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												
H1230	003	0	1	01	01	H1230_003_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		
H1230	013	0	1	01	01	H1230_013_0	14	Preferred Generic	3	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																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	14	Generic	3	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	22.00																11.00				11.00		0.36			0.36			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	14	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		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	14	Non-Preferred Brand	3	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	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	14	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				1567.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	14	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	12	Preferred Generic	3	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																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	12	Generic	3	11	1	2	2	1	111		01	111		1	30	60	90				2	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			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	12	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		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	12	Non-Preferred Brand	3	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	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	12	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				2147.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	12	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												
H1248	001	0	1	04	01	H1248_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								10.00	20.00	30.00					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	001	0	1	04	01	H1248_001_0	7	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	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	001	0	1	04	01	H1248_001_0	7	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	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	001	0	1	04	01	H1248_001_0	7	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	001	0	1	04	01	H1248_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								47.00	94.00	141.00					45.00	90.00	135.00					45.00	90.00	135.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	001	0	1	04	01	H1248_001_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	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	001	0	1	04	01	H1248_001_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1026.34	33						630.59	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	002	0	1	04	01	H1248_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								10.00	20.00	30.00					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	002	0	1	04	01	H1248_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								10.00	20.00	30.00					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	002	0	1	04	01	H1248_002_0	7	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	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	002	0	1	04	01	H1248_002_0	7	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	002	0	1	04	01	H1248_002_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					45.00	90.00	135.00					45.00	90.00	135.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	002	0	1	04	01	H1248_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		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 Drug, Specialty Tier												
H1248	002	0	1	04	01	H1248_002_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1028.67	33						628.16	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	003	0	1	04	01	H1248_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								10.00	20.00	30.00					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	003	0	1	04	01	H1248_003_0	7	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	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	003	0	1	04	01	H1248_003_0	7	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	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	003	0	1	04	01	H1248_003_0	7	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	003	0	1	04	01	H1248_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								47.00	94.00	141.00					45.00	90.00	135.00					45.00	90.00	135.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	003	0	1	04	01	H1248_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		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 Drug, Specialty Tier												
H1248	003	0	1	04	01	H1248_003_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1023.25	33						623.81	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	004	0	1	04	01	H1248_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								10.00	20.00	30.00					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	004	0	1	04	01	H1248_004_0	7	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	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	004	0	1	04	01	H1248_004_0	7	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	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	004	0	1	04	01	H1248_004_0	7	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	004	0	1	04	01	H1248_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								47.00	94.00	141.00					45.00	90.00	135.00					45.00	90.00	135.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	004	0	1	04	01	H1248_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		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 Drug, Specialty Tier												
H1248	004	0	1	04	01	H1248_004_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1032.49	33						633.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	005	0	1	04	01	H1248_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								10.00	20.00	30.00					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	005	0	1	04	01	H1248_005_0	7	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	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	005	0	1	04	01	H1248_005_0	7	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	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	005	0	1	04	01	H1248_005_0	7	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	005	0	1	04	01	H1248_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					45.00	90.00	135.00					45.00	90.00	135.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	005	0	1	04	01	H1248_005_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	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	005	0	1	04	01	H1248_005_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1029.33	33						631.24	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	006	0	1	04	01	H1248_006_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					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	006	0	1	04	01	H1248_006_0	7	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	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	006	0	1	04	01	H1248_006_0	7	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	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	006	0	1	04	01	H1248_006_0	7	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	006	0	1	04	01	H1248_006_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					45.00	90.00	135.00					45.00	90.00	135.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	006	0	1	04	01	H1248_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		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 Drug, Specialty Tier												
H1248	006	0	1	04	01	H1248_006_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1038.15	33						635.21	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H1278	001	0	1	04	01	H1278_001_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H1278	001	0	1	04	01	H1278_001_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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												
H1278	001	0	1	04	01	H1278_001_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				877.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	002	0	1	04	01	H1278_002_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H1278	002	0	1	04	01	H1278_002_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H1278	002	0	1	04	01	H1278_002_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	002	0	1	04	01	H1278_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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												
H1278	002	0	1	04	01	H1278_002_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				873.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H1278	003	0	1	04	01	H1278_003_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H1278	003	0	1	04	01	H1278_003_0	6	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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												
H1278	003	0	1	04	01	H1278_003_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				970.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	004	0	1	04	01	H1278_004_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H1278	004	0	1	04	01	H1278_004_0	6	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	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		
H1278	004	0	1	04	01	H1278_004_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H1278	004	0	1	04	01	H1278_004_0	6	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	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		
H1278	004	0	1	04	01	H1278_004_0	6	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	004	0	1	04	01	H1278_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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												
H1278	004	0	1	04	01	H1278_004_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1185.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H1278	005	0	1	04	01	H1278_005_0	6	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	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		
H1278	005	0	1	04	01	H1278_005_0	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H1278	005	0	1	04	01	H1278_005_0	6	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	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		
H1278	005	0	1	04	01	H1278_005_0	6	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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												
H1278	005	0	1	04	01	H1278_005_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				845.00	28		28																										28						28			28			28								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				2	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				2	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				2	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				2	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				2	2						90	30		31				1200.00	30		30																										30						30			30			30								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				2	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				2	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				2	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				2	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				2	2						90	30		31				1131.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	001	0	1	01	01	H1290_001_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												
H1290	001	0	1	01	01	H1290_001_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		
H1290	001	0	1	01	01	H1290_001_0	7	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												
H1290	001	0	1	01	01	H1290_001_0	7	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
H1290	001	0	1	01	01	H1290_001_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	001	0	1	01	01	H1290_001_0	7	Non-Preferred Drug	4	11	1	2	4	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												
H1290	001	0	1	01	01	H1290_001_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				773.57	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	002	0	1	01	01	H1290_002_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												
H1290	002	0	1	01	01	H1290_002_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		
H1290	002	0	1	01	01	H1290_002_0	7	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												
H1290	002	0	1	01	01	H1290_002_0	7	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
H1290	002	0	1	01	01	H1290_002_0	7	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					50.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	002	0	1	01	01	H1290_002_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																					212.50																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	002	0	1	01	01	H1290_002_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				755.96	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	003	0	1	01	01	H1290_003_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												
H1290	003	0	1	01	01	H1290_003_0	8	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		
H1290	003	0	1	01	01	H1290_003_0	8	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												
H1290	003	0	1	01	01	H1290_003_0	8	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
H1290	003	0	1	01	01	H1290_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																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	003	0	1	01	01	H1290_003_0	8	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												
H1290	003	0	1	01	01	H1290_003_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				759.40	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	004	0	1	01	01	H1290_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												
H1290	004	0	1	01	01	H1290_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										1		
H1290	004	0	1	01	01	H1290_004_0	7	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												
H1290	004	0	1	01	01	H1290_004_0	7	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
H1290	004	0	1	01	01	H1290_004_0	7	Preferred Brand	4	11	1	2	3	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												
H1290	004	0	1	01	01	H1290_004_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					187.50																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	004	0	1	01	01	H1290_004_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				752.67	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_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												
H1290	005	0	1	01	01	H1290_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										1		
H1290	005	0	1	01	01	H1290_005_0	7	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												
H1290	005	0	1	01	01	H1290_005_0	7	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
H1290	005	0	1	01	01	H1290_005_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																					87.50																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_005_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																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_005_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				751.32	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	006	0	1	01	01	H1290_006_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												
H1290	006	0	1	01	01	H1290_006_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		
H1290	006	0	1	01	01	H1290_006_0	7	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												
H1290	006	0	1	01	01	H1290_006_0	7	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
H1290	006	0	1	01	01	H1290_006_0	7	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				26.04	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	006	0	1	01	01	H1290_006_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				45.50	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	006	0	1	01	01	H1290_006_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				521.43	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	007	0	1	01	01	H1290_007_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												
H1290	007	0	1	01	01	H1290_007_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		
H1290	007	0	1	01	01	H1290_007_0	7	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												
H1290	007	0	1	01	01	H1290_007_0	7	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
H1290	007	0	1	01	01	H1290_007_0	7	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				26.20	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	007	0	1	01	01	H1290_007_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				42.64	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	007	0	1	01	01	H1290_007_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				521.95	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	008	0	1	01	01	H1290_008_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												
H1290	008	0	1	01	01	H1290_008_0	7	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												
H1290	008	0	1	01	01	H1290_008_0	7	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				26.47	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	008	0	1	01	01	H1290_008_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				42.87	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	008	0	1	01	01	H1290_008_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				522.74	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	009	0	1	01	01	H1290_009_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												
H1290	009	0	1	01	01	H1290_009_0	7	Generic	4	01	3	2	2	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												
H1290	009	0	1	01	01	H1290_009_0	7	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				24.46	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	009	0	1	01	01	H1290_009_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				41.31	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	009	0	1	01	01	H1290_009_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				517.48	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	010	0	1	01	01	H1290_010_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												
H1290	010	0	1	01	01	H1290_010_0	7	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					0.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	010	0	1	01	01	H1290_010_0	7	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				24.09	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	010	0	1	01	01	H1290_010_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				40.98	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	010	0	1	01	01	H1290_010_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				516.36	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	002	0	1	04	01	H1304_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								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												
H1304	002	0	1	04	01	H1304_002_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	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												
H1304	002	0	1	04	01	H1304_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	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												
H1304	002	0	1	04	01	H1304_002_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	002	0	1	04	01	H1304_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1352.40	28						1352.40	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_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												
H1304	004	0	1	04	01	H1304_004_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												
H1304	004	0	1	04	01	H1304_004_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												
H1304	004	0	1	04	01	H1304_004_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1593.90	33						1593.90	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	009	0	1	04	01	H1304_009_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												
H1304	009	0	1	04	01	H1304_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	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												
H1304	009	0	1	04	01	H1304_009_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												
H1304	009	0	1	04	01	H1304_009_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	009	0	1	04	01	H1304_009_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1352.40	28						1352.40	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	010	0	1	04	01	H1304_010_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												
H1304	010	0	1	04	01	H1304_010_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												
H1304	010	0	1	04	01	H1304_010_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												
H1304	010	0	1	04	01	H1304_010_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	010	0	1	04	01	H1304_010_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1593.90	33						1593.90	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	1	1	01	01	H1350_015_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				0.00			0.17	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		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00				12.00				6.00			0.40	0.20		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		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											45.00	90.00	135.00				35.00	70.00	105.00				45.00				35.00			1.50	1.17		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		111	01		111	1				30	60	90	1	2				30	60	90	30		31								95.00	190.00	285.00					85.00	170.00	255.00											95.00	190.00	285.00				85.00	170.00	255.00				95.00				85.00			3.17	2.83		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		010	01		010	1				30								30			30		31											990.00	33						990.00	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		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												
H1350	015	2	1	01	01	H1350_015_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	36.00					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00				12.00				6.00			0.40	0.20		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		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											45.00	90.00	135.00				35.00	70.00	105.00				45.00				35.00			1.50	1.17		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		111	01		111	1				30	60	90	1	2				30	60	90	30		31								95.00	190.00	285.00					85.00	170.00	255.00											95.00	190.00	285.00				85.00	170.00	255.00				95.00				85.00			3.17	2.83		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		010	01		010	1				30								30			30		31											990.00	33						990.00	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		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				0.00			0.33	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		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	36.00				20.00				12.00			0.67	0.40		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		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				37.00			1.57	1.23		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		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	270.00				100.00				90.00			3.33	3.00		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		010	01		010	1				30								30			30		31											990.00	29						990.00	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		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				0.00			0.33	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		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	36.00				20.00				12.00			0.67	0.40		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		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				37.00			1.57	1.23		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		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	270.00				100.00				90.00			3.33	3.00		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		010	01		010	1				30								30			30		31											990.00	29						990.00	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		111	01		111	1				30	60	90	1	2				30	60	90	30		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				0.00			0.50	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		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				6.00			0.67	0.20		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		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					31.00	62.00	93.00											47.00	94.00	141.00				31.00	62.00	93.00				47.00				31.00			1.57	1.03		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		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	270.00				100.00				90.00			3.33	3.00		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		010	01		010	1				30								30			30		31											990.00	33						990.00	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		111	01		111	1				30	60	90	1	2				30	60	90	30		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				0.00			0.50	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		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				6.00			0.67	0.20		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		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					31.00	62.00	93.00											47.00	94.00	141.00				31.00	62.00	93.00				47.00				31.00			1.57	1.03		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		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	270.00				100.00				90.00			3.33	3.00		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		010	01		010	1				30								30			30		31											990.00	33						990.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	021	0	1	01	01	H1350_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								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				0.00			0.50	0.00		0.50	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	021	0	1	01	01	H1350_021_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				6.00			0.67	0.20		0.67	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	021	0	1	01	01	H1350_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					31.00	62.00	93.00											47.00	94.00	141.00				31.00	62.00	93.00				47.00				31.00			1.57	1.03		1.57	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	021	0	1	01	01	H1350_021_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								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	021	0	1	01	01	H1350_021_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	31						990.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	022	1	1	01	01	H1350_022_1	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					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				0.00			0.50	0.00		0.50	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	022	1	1	01	01	H1350_022_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					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				6.00			0.67	0.20		0.67	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	022	1	1	01	01	H1350_022_1	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					31.00	62.00	93.00											47.00	94.00	141.00				31.00	62.00	93.00				47.00				31.00			1.57	1.03		1.57	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	022	1	1	01	01	H1350_022_1	5	Non-Preferred Drug	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					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	022	1	1	01	01	H1350_022_1	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	30						990.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	022	2	1	01	01	H1350_022_2	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					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				0.00			0.50	0.00		0.50	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	022	2	1	01	01	H1350_022_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					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				6.00			0.67	0.20		0.67	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	022	2	1	01	01	H1350_022_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					31.00	62.00	93.00											47.00	94.00	141.00				31.00	62.00	93.00				47.00				31.00			1.57	1.03		1.57	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	022	2	1	01	01	H1350_022_2	5	Non-Preferred Drug	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					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	022	2	1	01	01	H1350_022_2	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	30						990.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	001	0	1	01	01	H1352_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	0.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	3	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	0.00																					0.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_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	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	3	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																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	3	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 Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_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	0.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	3	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	0.00																					0.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_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	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	3	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																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	3	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 Brand, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_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					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	8	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	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					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	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					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	8	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	7	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	7	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	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					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	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					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	7	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												
H1393	001	0	1	04	01	H1393_001_0	11	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		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1393	001	0	1	04	01	H1393_001_0	11	Generic	4	11	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												
H1393	001	0	1	04	01	H1393_001_0	11	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 Drug, Specialty Tier												
H1393	001	0	1	04	01	H1393_001_0	11	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1393	001	0	1	04	01	H1393_001_0	11	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				624.00	31		31																		31		31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1393	002	0	1	04	01	H1393_002_0	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1393	002	0	1	04	01	H1393_002_0	11	Generic	4	11	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												
H1393	002	0	1	04	01	H1393_002_0	11	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 Drug, Specialty Tier												
H1393	002	0	1	04	01	H1393_002_0	11	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1393	002	0	1	04	01	H1393_002_0	11	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				652.00	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	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	24.00					5.00	10.00	10.00											12.00	24.00	24.00				0.00	0.00	0.00				12.00				12.00			0.40	0.17		0.40	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	34.00					10.00	20.00	20.00											17.00	34.00	34.00				0.00	0.00	0.00				17.00				17.00			0.57	0.33		0.57	0.00	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	4	Preferred Brand	4	11	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											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												
H1415	021	0	1	02	01	H1415_021_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.20	48	48	48				98.74	45	45	45										48	48	48				45	45	45			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											810.48	33						797.97	33												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	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												
H1416	009	0	1	02	01	H1416_009_0	3	Preferred Generic	4	11	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		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1416	009	0	1	02	01	H1416_009_0	3	Generic	4	11	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		0.00				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		94.00				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				65.73	50		50																								50		50				50		50			50			50								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					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H1416	023	0	1	01	01	H1416_023_0	3	Generic	4	11	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		0.00				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	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		94.00				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	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				76.19	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	3	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												
H1416	024	0	1	02	01	H1416_024_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	024	0	1	02	01	H1416_024_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H1416	024	0	1	02	01	H1416_024_0	3	Generic	4	11	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		0.00				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	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		94.00				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	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				62.46	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	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												
H1416	026	0	1	02	01	H1416_026_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	026	0	1	02	01	H1416_026_0	3	Generic	4	11	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		0.00				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	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		80.00				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	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		198.00				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	3	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												
H1416	031	0	1	02	01	H1416_031_0	3	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												
H1416	031	0	1	02	01	H1416_031_0	3	Generic	4	11	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		0.00				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		94.00				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		198.00				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					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	032	0	1	02	01	H1416_032_0	3	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												
H1416	032	0	1	02	01	H1416_032_0	3	Generic	4	11	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		0.00				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	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		80.00				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	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		198.00				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	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												
H1416	033	0	1	01	01	H1416_033_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	033	0	1	01	01	H1416_033_0	3	Generic	3	11	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		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	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	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												
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				80.73	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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	034	0	1	01	01	H1416_034_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	034	0	1	01	01	H1416_034_0	3	Generic	3	11	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		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	034	0	1	01	01	H1416_034_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		94.00				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	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				76.69	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	3	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												
H1416	035	0	1	01	01	H1416_035_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	035	0	1	01	01	H1416_035_0	3	Generic	3	11	1	2	2	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	035	0	1	01	01	H1416_035_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		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	035	0	1	01	01	H1416_035_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.91	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	3	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												
H1416	036	0	1	01	01	H1416_036_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	036	0	1	01	01	H1416_036_0	4	Generic	3	11	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		0.00				5.00				5.00		0.17				0.17	0.17	0.16	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		94.00				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				91.12	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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	038	0	1	01	01	H1416_038_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	038	0	1	01	01	H1416_038_0	3	Generic	4	11	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		0.00				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	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		94.00				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	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		198.00				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	3	Specialty Tier	4	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 Drug, Specialty Tier												
H1416	039	0	1	01	01	H1416_039_0	3	Preferred Generic	4	11	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	039	0	1	01	01	H1416_039_0	3	Generic	4	11	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		0.00				12.00				12.00		0.40				0.40	0.40	0.39	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		94.00				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		198.00				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					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	041	0	1	01	01	H1416_041_0	3	Preferred Generic	2	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												
H1416	041	0	1	01	01	H1416_041_0	3	Generic	2	11	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		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	041	0	1	01	01	H1416_041_0	3	Preferred Brand	2	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												
H1416	041	0	1	01	01	H1416_041_0	3	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		198.00				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	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												
H1416	042	0	1	01	01	H1416_042_0	3	Preferred Generic	2	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												
H1416	042	0	1	01	01	H1416_042_0	3	Generic	2	11	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		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	042	0	1	01	01	H1416_042_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																									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												
H1416	042	0	1	01	01	H1416_042_0	3	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		198.00				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	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												
H1416	043	0	1	01	01	H1416_043_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	043	0	1	01	01	H1416_043_0	3	Generic	3	11	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		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	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	46.00		138.00																									46.00		138.00				46.00		92.00				46.00				46.00		1.53				1.53	1.53	1.48	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				82.16	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					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	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	044	0	1	01	01	H1416_044_0	3	Generic	3	11	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		0.00				16.00				16.00		0.53				0.53	0.53	0.52	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		94.00				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				79.34	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					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	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	048	0	1	01	01	H1416_048_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H1416	048	0	1	01	01	H1416_048_0	3	Generic	4	11	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		0.00				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		94.00				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				81.28	50		50																								50		50				50		50			50			50								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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	052	1	1	01	01	H1416_052_1	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	052	1	1	01	01	H1416_052_1	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H1416	052	1	1	01	01	H1416_052_1	3	Generic	4	11	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		0.00				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	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		94.00				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	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				44.40	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	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												
H1416	052	2	1	01	01	H1416_052_2	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	052	2	1	01	01	H1416_052_2	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H1416	052	2	1	01	01	H1416_052_2	4	Generic	4	11	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		0.00				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		94.00				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				44.40	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					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	055	0	1	01	01	H1416_055_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	055	0	1	01	01	H1416_055_0	3	Generic	4	11	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		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	055	0	1	01	01	H1416_055_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	055	0	1	01	01	H1416_055_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		198.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	055	0	1	01	01	H1416_055_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												
H1426	001	0	1	01	01	H1426_001_0	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				2	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 Brand, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				2	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 Brand, Specialty Tier										1		
H1426	001	0	1	01	01	H1426_001_0	7	Generic	4	01	3	2	2	1	110		01	100		1	31		90				2	2			90				31		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	7	Generic	4	01	3	2	2	3	110		01	100		1	31		90				2	2			90				31		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1426	001	0	1	01	01	H1426_001_0	7	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				2	2			90				31		31	35.00		70.00																					70.00																35.00				35.00		1.13						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	31		90				2	2			90				31		31	90.00		180.00																					180.00																90.00				90.00		2.90						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				184.47	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				2	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 Brand, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				2	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 Brand, Specialty Tier										1		
H1426	002	0	1	01	01	H1426_002_0	7	Generic	4	01	3	2	2	1	110		01	100		1	31		90				2	2			90				31		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	7	Generic	4	01	3	2	2	3	110		01	100		1	31		90				2	2			90				31		31	5.00		10.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1426	002	0	1	01	01	H1426_002_0	7	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				2	2			90				31		31	35.00		70.00																					70.00																35.00				35.00		1.13						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	31		90				2	2			90				31		31	90.00		180.00																					180.00																90.00				90.00		2.90						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				184.47	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	7	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				2	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 Brand, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	7	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				2	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 Brand, Specialty Tier										1		
H1426	003	0	1	01	01	H1426_003_0	7	Generic	4	01	3	1	2	1	110		01	100		1	31		90				2	2			90				31		31				1.25	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	7	Preferred Brand	4	10	1	1	3	1	110		01	100		1	31		90				2	2			90				31		31				15.08	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	7	Non-Preferred Brand	4	10	1	1	4	1	110		01	100		1	31		90				2	2			90				31		31				11.80	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				168.57	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1436	001	0	1	01	01	H1436_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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	001	0	1	01	01	H1436_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	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	001	0	1	01	01	H1436_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 Drug, Specialty Tier, Select Care Drugs												
H1436	001	0	1	01	01	H1436_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, Select Care Drugs												
H1436	001	0	1	01	01	H1436_001_0	6	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, Select Care Drugs												
H1436	001	0	1	01	01	H1436_001_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	002	0	1	01	01	H1436_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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	002	0	1	01	01	H1436_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	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	002	0	1	01	01	H1436_002_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 Drug, Specialty Tier, Select Care Drugs												
H1436	002	0	1	01	01	H1436_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, Select Care Drugs												
H1436	002	0	1	01	01	H1436_002_0	6	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, Select Care Drugs												
H1436	002	0	1	01	01	H1436_002_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	003	0	1	01	01	H1436_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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	003	0	1	01	01	H1436_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	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	003	0	1	01	01	H1436_003_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 Drug, Specialty Tier, Select Care Drugs												
H1436	003	0	1	01	01	H1436_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, Select Care Drugs												
H1436	003	0	1	01	01	H1436_003_0	6	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, Select Care Drugs												
H1436	003	0	1	01	01	H1436_003_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	004	0	1	01	01	H1436_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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	6	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, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_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 Drug, Specialty Tier, Select Care Drugs												
H1436	004	0	1	01	01	H1436_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, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	6	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, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	006	0	1	01	01	H1436_006_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												
H1436	006	0	1	01	01	H1436_006_0	6	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	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												
H1436	006	0	1	01	01	H1436_006_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												
H1436	006	0	1	01	01	H1436_006_0	6	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												
H1436	006	0	1	01	01	H1436_006_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												
H1463	003	0	1	01	01	H1463_003_0	12	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	12	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	12	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	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											68.11	50	50	50				65.49	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	12	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	12	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	12	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	12	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	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											90.66	50	50	50				87.99	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	12	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	12	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	12	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	12	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	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											72.17	50	50	50				69.90	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	12	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	12	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	12	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	12	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	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											64.61	50	50	50				61.90	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	12	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	12	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	12	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	12	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	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											65.62	50	50	50				62.92	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	12	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	12	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	12	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	12	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	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											69.27	50	50	50				67.64	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	12	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	12	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	12	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	12	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	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											73.49	50	50	50				71.43	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	12	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	12	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	12	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	12	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	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											73.76	50	50	50				71.06	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	12	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												
H1463	021	0	1	01	01	H1463_021_0	12	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	021	0	1	01	01	H1463_021_0	12	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	021	0	1	01	01	H1463_021_0	12	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	021	0	1	01	01	H1463_021_0	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											71.81	50	50	50				69.51	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	021	0	1	01	01	H1463_021_0	12	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	022	0	1	02	01	H1463_022_0	12	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	022	0	1	02	01	H1463_022_0	12	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	022	0	1	02	01	H1463_022_0	12	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	022	0	1	02	01	H1463_022_0	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											64.92	50	50	50				62.23	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	022	0	1	02	01	H1463_022_0	12	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	023	0	1	01	01	H1463_023_0	12	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												
H1463	023	0	1	01	01	H1463_023_0	12	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	30.00	37.50																15.00				15.00			0.50	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	023	0	1	01	01	H1463_023_0	12	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	023	0	1	01	01	H1463_023_0	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											71.54	50	50	50				69.23	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	023	0	1	01	01	H1463_023_0	12	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	024	0	1	01	01	H1463_024_0	12	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												
H1463	024	0	1	01	01	H1463_024_0	12	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	30.00	37.50																15.00				15.00			0.50	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	024	0	1	01	01	H1463_024_0	12	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	024	0	1	01	01	H1463_024_0	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											71.54	50	50	50				69.23	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	024	0	1	01	01	H1463_024_0	12	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	025	0	1	02	01	H1463_025_0	11	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												
H1463	025	0	1	02	01	H1463_025_0	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	37.50					15.00	30.00	30.00					15.00	30.00	37.50																15.00				15.00			0.50	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	025	0	1	02	01	H1463_025_0	11	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	025	0	1	02	01	H1463_025_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											71.54	50	50	50				69.23	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	025	0	1	02	01	H1463_025_0	11	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	032	0	1	01	01	H1463_032_0	12	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												
H1463	032	0	1	01	01	H1463_032_0	12	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	30.00	37.50																15.00				15.00			0.50	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	032	0	1	01	01	H1463_032_0	12	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	032	0	1	01	01	H1463_032_0	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											72.87	50	50	50				70.57	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	032	0	1	01	01	H1463_032_0	12	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	033	0	1	01	01	H1463_033_0	12	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												
H1463	033	0	1	01	01	H1463_033_0	12	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	30.00	37.50																15.00				15.00			0.50	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	033	0	1	01	01	H1463_033_0	12	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	033	0	1	01	01	H1463_033_0	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											72.87	50	50	50				70.57	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	033	0	1	01	01	H1463_033_0	12	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	034	0	1	02	01	H1463_034_0	12	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												
H1463	034	0	1	02	01	H1463_034_0	12	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	30.00	37.50																15.00				15.00			0.50	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	034	0	1	02	01	H1463_034_0	12	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	034	0	1	02	01	H1463_034_0	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											72.87	50	50	50				70.57	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	034	0	1	02	01	H1463_034_0	12	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												
H1468	007	0	1	01	01	H1468_007_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												
H1468	007	0	1	01	01	H1468_007_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_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												
H1468	013	0	1	01	01	H1468_013_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					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												
H1468	013	0	1	01	01	H1468_013_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	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 Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_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												
H1468	014	0	1	01	01	H1468_014_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	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 Drug, Specialty Tier												
H1468	016	0	1	01	01	H1468_016_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					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												
H1468	016	0	1	01	01	H1468_016_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	016	0	1	01	01	H1468_016_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	016	0	1	01	01	H1468_016_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	016	0	1	01	01	H1468_016_0	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 Drug, Specialty Tier												
H1468	017	0	1	01	01	H1468_017_0	7	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, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_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		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	7	Non-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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	7	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	7	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												
H1475	001	0	1	01	01	H1475_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								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			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1475	001	0	1	01	01	H1475_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					6.00	12.00	18.00					6.00	12.00	18.00																15.00				15.00			0.50	0.20	0.20			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1475	001	0	1	01	01	H1475_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					39.00	78.00	117.00					39.00	78.00	117.00																47.00				47.00			1.57	1.30	1.30			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1475	001	0	1	01	01	H1475_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								99.00	198.00	297.00					85.00	170.00	255.00					85.00	170.00	255.00																99.00				99.00			3.30	2.83	2.83			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1475	001	0	1	01	01	H1475_001_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, Select Care Drugs												
H1475	001	0	1	01	01	H1475_001_0	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 Drug, Specialty Tier, Select Care Drugs												
H1475	002	0	1	01	01	H1475_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								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			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1475	002	0	1	01	01	H1475_002_0	7	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					6.00	12.00	18.00					6.00	12.00	18.00																15.00				15.00			0.50	0.20	0.20			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1475	002	0	1	01	01	H1475_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								47.00	94.00	141.00					39.00	78.00	117.00					39.00	78.00	117.00																47.00				47.00			1.57	1.30	1.30			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1475	002	0	1	01	01	H1475_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		31								99.00	198.00	297.00					85.00	170.00	255.00					85.00	170.00	255.00																99.00				99.00			3.30	2.83	2.83			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1475	002	0	1	01	01	H1475_002_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 Drug, Specialty Tier, Select Care Drugs												
H1475	002	0	1	01	01	H1475_002_0	7	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 Drug, Specialty Tier, Select Care Drugs												
H1537	004	0	1	04	01	H1537_004_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				870.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1587	003	0	1	02	01	H1587_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	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	6	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	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 Drug, Specialty Tier												
H1587	003	0	1	02	01	H1587_003_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																			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												
H1587	003	0	1	02	01	H1587_003_0	6	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	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		0.00																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	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00		24.00																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	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	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												
H1607	012	0	1	04	01	H1607_012_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1607	014	0	1	04	01	H1607_014_0	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		0.00																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	014	0	1	04	01	H1607_014_0	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00		26.00																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												
H1607	014	0	1	04	01	H1607_014_0	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	014	0	1	04	01	H1607_014_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	014	0	1	04	01	H1607_014_0	7	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												
H1607	014	0	1	04	01	H1607_014_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	014	0	1	04	01	H1607_014_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	4	Preferred Generic	4	01	1	2	1	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												
H1608	001	0	1	04	01	H1608_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								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		
H1608	001	0	1	04	01	H1608_001_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					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		
H1608	001	0	1	04	01	H1608_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	001	0	1	04	01	H1608_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												
H1608	001	0	1	04	01	H1608_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												
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								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												
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								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		
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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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												
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								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		
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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	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												
H1608	008	0	1	04	01	H1608_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								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		
H1608	008	0	1	04	01	H1608_008_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					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		
H1608	008	0	1	04	01	H1608_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	008	0	1	04	01	H1608_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												
H1608	008	0	1	04	01	H1608_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												
H1608	012	0	1	04	01	H1608_012_0	5	Preferred Generic	4	01	1	2	1	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												
H1608	012	0	1	04	01	H1608_012_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00					9.00			9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	012	0	1	04	01	H1608_012_0	5	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_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					10.00	20.00	30.00											15.00	30.00	45.00				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										1		
H1608	012	0	1	04	01	H1608_012_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_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	012	0	1	04	01	H1608_012_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	013	0	1	04	01	H1608_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	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	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		
H1608	013	0	1	04	01	H1608_013_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	0.00																			7.00	14.00	0.00																	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	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	0.00																			7.00	14.00	0.00																	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	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												
H1608	013	0	1	04	01	H1608_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			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	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												
H1608	016	0	1	04	01	H1608_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	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	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		
H1608	016	0	1	04	01	H1608_016_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	0.00																			7.00	14.00	0.00																	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	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	0.00																			7.00	14.00	0.00																	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	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												
H1608	016	0	1	04	01	H1608_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			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	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												
H1608	017	0	1	04	01	H1608_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	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	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		
H1608	017	0	1	04	01	H1608_017_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	0.00																			7.00	14.00	0.00																	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	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	0.00																			7.00	14.00	0.00																	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	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												
H1608	017	0	1	04	01	H1608_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			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	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												
H1608	018	0	1	04	01	H1608_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	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	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		
H1608	018	0	1	04	01	H1608_018_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	0.00																			7.00	14.00	0.00																	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	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	0.00																			7.00	14.00	0.00																	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	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												
H1608	018	0	1	04	01	H1608_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			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	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												
H1608	021	0	1	04	01	H1608_021_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												
H1608	021	0	1	04	01	H1608_021_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		
H1608	021	0	1	04	01	H1608_021_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	0.00																			7.00	14.00	0.00																	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	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	0.00																			7.00	14.00	0.00																	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	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												
H1608	021	0	1	04	01	H1608_021_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												
H1608	021	0	1	04	01	H1608_021_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												
H1608	024	0	1	04	01	H1608_024_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												
H1608	024	0	1	04	01	H1608_024_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		
H1608	024	0	1	04	01	H1608_024_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	0.00																			7.00	14.00	0.00																	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	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	0.00																			7.00	14.00	0.00																	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	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												
H1608	024	0	1	04	01	H1608_024_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												
H1608	024	0	1	04	01	H1608_024_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												
H1608	026	0	1	04	01	H1608_026_0	3	Preferred Generic	4	01	1	2	1	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												
H1608	026	0	1	04	01	H1608_026_0	3	Preferred Generic	4	01	1	2	1	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		
H1608	026	0	1	04	01	H1608_026_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1608	026	0	1	04	01	H1608_026_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H1608	026	0	1	04	01	H1608_026_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_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	026	0	1	04	01	H1608_026_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	027	0	1	04	01	H1608_027_0	2	Preferred Generic	4	01	1	2	1	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												
H1608	027	0	1	04	01	H1608_027_0	2	Preferred Generic	4	01	1	2	1	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		
H1608	027	0	1	04	01	H1608_027_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1608	027	0	1	04	01	H1608_027_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H1608	027	0	1	04	01	H1608_027_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	028	0	1	04	01	H1608_028_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_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	10.00					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		
H1608	028	0	1	04	01	H1608_028_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_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	028	0	1	04	01	H1608_028_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												
H1608	029	0	1	04	01	H1608_029_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	029	0	1	04	01	H1608_029_0	2	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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	2	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	10.00					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		
H1608	029	0	1	04	01	H1608_029_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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												
H1608	031	0	1	04	01	H1608_031_0	2	Preferred Generic	4	01	1	2	1	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		
H1608	031	0	1	04	01	H1608_031_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	031	0	1	04	01	H1608_031_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	031	0	1	04	01	H1608_031_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	031	0	1	04	01	H1608_031_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	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												
H1608	035	0	1	04	01	H1608_035_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		
H1608	035	0	1	04	01	H1608_035_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	035	0	1	04	01	H1608_035_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	035	0	1	04	01	H1608_035_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												
H1608	035	0	1	04	01	H1608_035_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												
H1608	035	0	1	04	01	H1608_035_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												
H1608	036	0	1	04	01	H1608_036_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												
H1608	036	0	1	04	01	H1608_036_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		
H1608	036	0	1	04	01	H1608_036_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	0.00																			7.00	14.00	0.00																	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	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	0.00																			7.00	14.00	0.00																	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	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												
H1608	036	0	1	04	01	H1608_036_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												
H1608	036	0	1	04	01	H1608_036_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												
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								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												
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								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		
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	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												
H1608	038	0	1	04	01	H1608_038_0	3	Preferred Generic	4	01	1	2	1	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		
H1608	038	0	1	04	01	H1608_038_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1608	038	0	1	04	01	H1608_038_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H1608	038	0	1	04	01	H1608_038_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	038	0	1	04	01	H1608_038_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	038	0	1	04	01	H1608_038_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	039	0	1	04	01	H1608_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	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	039	0	1	04	01	H1608_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	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	039	0	1	04	01	H1608_039_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	039	0	1	04	01	H1608_039_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	039	0	1	04	01	H1608_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																			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	039	0	1	04	01	H1608_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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	039	0	1	04	01	H1608_039_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												
H1608	040	0	1	04	01	H1608_040_0	2	Preferred Generic	4	01	1	2	1	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												
H1608	040	0	1	04	01	H1608_040_0	2	Preferred Generic	4	01	1	2	1	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		
H1608	040	0	1	04	01	H1608_040_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1608	040	0	1	04	01	H1608_040_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H1608	040	0	1	04	01	H1608_040_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	040	0	1	04	01	H1608_040_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	040	0	1	04	01	H1608_040_0	2	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	041	0	1	04	01	H1608_041_0	2	Preferred Generic	4	01	1	2	1	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												
H1608	041	0	1	04	01	H1608_041_0	2	Preferred Generic	4	01	1	2	1	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		
H1608	041	0	1	04	01	H1608_041_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	041	0	1	04	01	H1608_041_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	041	0	1	04	01	H1608_041_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	041	0	1	04	01	H1608_041_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	041	0	1	04	01	H1608_041_0	2	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	043	0	1	04	01	H1608_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								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												
H1608	043	0	1	04	01	H1608_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								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		
H1608	043	0	1	04	01	H1608_043_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	043	0	1	04	01	H1608_043_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					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		
H1608	043	0	1	04	01	H1608_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	043	0	1	04	01	H1608_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												
H1608	043	0	1	04	01	H1608_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												
H1608	047	0	1	04	01	H1608_047_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												
H1608	047	0	1	04	01	H1608_047_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		
H1608	047	0	1	04	01	H1608_047_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	047	0	1	04	01	H1608_047_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	047	0	1	04	01	H1608_047_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												
H1608	047	0	1	04	01	H1608_047_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												
H1608	047	0	1	04	01	H1608_047_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												
H1608	048	0	1	04	01	H1608_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								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												
H1608	048	0	1	04	01	H1608_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								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		
H1608	048	0	1	04	01	H1608_048_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1608	048	0	1	04	01	H1608_048_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H1608	048	0	1	04	01	H1608_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	048	0	1	04	01	H1608_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												
H1608	048	0	1	04	01	H1608_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												
H1608	050	0	1	04	01	H1608_050_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												
H1608	050	0	1	04	01	H1608_050_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		
H1608	050	0	1	04	01	H1608_050_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	050	0	1	04	01	H1608_050_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	050	0	1	04	01	H1608_050_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												
H1608	050	0	1	04	01	H1608_050_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												
H1608	050	0	1	04	01	H1608_050_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												
H1608	051	0	1	04	01	H1608_051_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												
H1608	051	0	1	04	01	H1608_051_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		
H1608	051	0	1	04	01	H1608_051_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	051	0	1	04	01	H1608_051_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	051	0	1	04	01	H1608_051_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												
H1608	051	0	1	04	01	H1608_051_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												
H1608	051	0	1	04	01	H1608_051_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												
H1609	001	0	1	01	01	H1609_001_0	3	Preferred Generic	4	01	1	2	1	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	001	0	1	01	01	H1609_001_0	3	Preferred Generic	4	01	1	2	1	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	001	0	1	01	01	H1609_001_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					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		
H1609	001	0	1	01	01	H1609_001_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_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												
H1609	001	0	1	01	01	H1609_001_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												
H1609	009	0	1	01	01	H1609_009_0	2	Preferred Generic	4	01	1	2	1	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	009	0	1	01	01	H1609_009_0	2	Preferred Generic	4	01	1	2	1	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	009	0	1	01	01	H1609_009_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					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		
H1609	009	0	1	01	01	H1609_009_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	3	Preferred Generic	4	01	3	2	1	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	3	Preferred Generic	4	01	3	2	1	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	014	0	1	01	01	H1609_014_0	3	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	014	0	1	01	01	H1609_014_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	014	0	1	01	01	H1609_014_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					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	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					85.00	170.00	255.00											100.00	200.00	300.00				85.00	170.00	255.00					100.00			100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	014	0	1	01	01	H1609_014_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												
H1609	015	0	1	01	01	H1609_015_0	4	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	4	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	4	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	4	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	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												
H1609	015	0	1	01	01	H1609_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			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	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	016	0	1	01	01	H1609_016_0	3	Preferred Generic	4	01	3	2	1	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	3	Preferred Generic	4	01	3	2	1	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	016	0	1	01	01	H1609_016_0	3	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	016	0	1	01	01	H1609_016_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	016	0	1	01	01	H1609_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					0.00	0.00	0.00											47.00	94.00	141.00				0.00	0.00	0.00					47.00			47.00			1.57	0.00		1.57	0.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	016	0	1	01	01	H1609_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					35.00	70.00	105.00											100.00	200.00	300.00				35.00	70.00	105.00					100.00			100.00			3.33	1.17		3.33	1.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	016	0	1	01	01	H1609_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												
H1609	017	0	1	01	01	H1609_017_0	4	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	4	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	4	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	4	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	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												
H1609	017	0	1	01	01	H1609_017_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												
H1609	017	0	1	01	01	H1609_017_0	4	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	018	0	1	01	01	H1609_018_0	3	Preferred Generic	4	01	3	2	1	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	3	Preferred Generic	4	01	3	2	1	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	018	0	1	01	01	H1609_018_0	3	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	018	0	1	01	01	H1609_018_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	018	0	1	01	01	H1609_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					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	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					85.00	170.00	255.00											100.00	200.00	300.00				85.00	170.00	255.00					100.00			100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	018	0	1	01	01	H1609_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												
H1609	019	0	1	01	01	H1609_019_0	2	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	2	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	2	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	2	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	2	Preferred Brand	4	11	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	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	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	2	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	020	0	1	01	01	H1609_020_0	2	Preferred Generic	4	01	3	2	1	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	2	Preferred Generic	4	01	3	2	1	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	2	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	020	0	1	01	01	H1609_020_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	020	0	1	01	01	H1609_020_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	020	0	1	01	01	H1609_020_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	3	2	1	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	2	Preferred Generic	4	01	3	2	1	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	2	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	021	0	1	01	01	H1609_021_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	021	0	1	01	01	H1609_021_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	021	0	1	01	01	H1609_021_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	3	Preferred Generic	4	01	3	2	1	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	3	Preferred Generic	4	01	3	2	1	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	3	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	022	0	1	01	01	H1609_022_0	3	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	022	0	1	01	01	H1609_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	022	0	1	01	01	H1609_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												
H1609	022	0	1	01	01	H1609_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												
H1609	023	0	1	01	01	H1609_023_0	2	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	2	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	2	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	2	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	2	Preferred Brand	4	11	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	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	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	2	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	024	0	1	01	01	H1609_024_0	2	Preferred Generic	4	01	3	2	1	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	024	0	1	01	01	H1609_024_0	2	Preferred Generic	4	01	3	2	1	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	024	0	1	01	01	H1609_024_0	2	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	024	0	1	01	01	H1609_024_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	024	0	1	01	01	H1609_024_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	024	0	1	01	01	H1609_024_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	3	2	1	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	2	Preferred Generic	4	01	3	2	1	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	2	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	025	0	1	01	01	H1609_025_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	025	0	1	01	01	H1609_025_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	025	0	1	01	01	H1609_025_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	3	2	1	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	026	0	1	01	01	H1609_026_0	2	Preferred Generic	4	01	3	2	1	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	026	0	1	01	01	H1609_026_0	2	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	026	0	1	01	01	H1609_026_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	026	0	1	01	01	H1609_026_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	026	0	1	01	01	H1609_026_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	027	0	1	01	01	H1609_027_0	2	Preferred Generic	4	01	3	2	1	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	027	0	1	01	01	H1609_027_0	2	Preferred Generic	4	01	3	2	1	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	027	0	1	01	01	H1609_027_0	2	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	027	0	1	01	01	H1609_027_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	027	0	1	01	01	H1609_027_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	027	0	1	01	01	H1609_027_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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	2	Preferred Generic	4	01	1	2	1	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	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	028	0	1	02	01	H1609_028_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H1609	028	0	1	02	01	H1609_028_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	028	0	1	02	01	H1609_028_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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												
H1609	034	0	1	01	01	H1609_034_0	2	Preferred Generic	4	01	3	2	1	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	034	0	1	01	01	H1609_034_0	2	Preferred Generic	4	01	3	2	1	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	034	0	1	01	01	H1609_034_0	2	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	034	0	1	01	01	H1609_034_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	034	0	1	01	01	H1609_034_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	034	0	1	01	01	H1609_034_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	034	0	1	01	01	H1609_034_0	2	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	035	0	1	01	01	H1609_035_0	2	Preferred Generic	4	01	3	2	1	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	035	0	1	01	01	H1609_035_0	2	Preferred Generic	4	01	3	2	1	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	035	0	1	01	01	H1609_035_0	2	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	035	0	1	01	01	H1609_035_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	035	0	1	01	01	H1609_035_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	035	0	1	01	01	H1609_035_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	035	0	1	01	01	H1609_035_0	2	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	037	0	1	01	01	H1609_037_0	2	Preferred Generic	4	01	3	2	1	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	037	0	1	01	01	H1609_037_0	2	Preferred Generic	4	01	3	2	1	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	037	0	1	01	01	H1609_037_0	2	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	037	0	1	01	01	H1609_037_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	037	0	1	01	01	H1609_037_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	037	0	1	01	01	H1609_037_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	037	0	1	01	01	H1609_037_0	2	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	038	0	1	01	01	H1609_038_0	2	Preferred Generic	4	01	3	2	1	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	038	0	1	01	01	H1609_038_0	2	Preferred Generic	4	01	3	2	1	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	038	0	1	01	01	H1609_038_0	2	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1609	038	0	1	01	01	H1609_038_0	2	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		3
H1609	038	0	1	01	01	H1609_038_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	038	0	1	01	01	H1609_038_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	038	0	1	01	01	H1609_038_0	2	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	039	0	1	01	01	H1609_039_0	2	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	039	0	1	01	01	H1609_039_0	2	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	039	0	1	01	01	H1609_039_0	2	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	039	0	1	01	01	H1609_039_0	2	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	039	0	1	01	01	H1609_039_0	2	Preferred Brand	4	11	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	039	0	1	01	01	H1609_039_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	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	039	0	1	01	01	H1609_039_0	2	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	040	0	1	01	01	H1609_040_0	2	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	040	0	1	01	01	H1609_040_0	2	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	040	0	1	01	01	H1609_040_0	2	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	040	0	1	01	01	H1609_040_0	2	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	040	0	1	01	01	H1609_040_0	2	Preferred Brand	4	11	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	040	0	1	01	01	H1609_040_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	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	040	0	1	01	01	H1609_040_0	2	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	001	0	1	01	01	H1610_001_0	3	Preferred Generic	3	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	0.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	001	0	1	01	01	H1610_001_0	3	Generic	3	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	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 Drug, Specialty Tier												
H1610	001	0	1	01	01	H1610_001_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																			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												
H1610	001	0	1	01	01	H1610_001_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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1610	001	0	1	01	01	H1610_001_0	3	Specialty Tier	3	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												
H1659	001	0	1	04	01	H1659_001_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		0.00													30.00						0.00				10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	6	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					8.00		0.00													39.00						0.00				13.00				13.00			0.43	0.27				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_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					30.00		75.00													120.00						75.00				40.00				40.00			1.33	1.00				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	6	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		200.00													270.00						200.00				90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	6	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												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	6	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					7.00		0.00													36.00						0.00				12.00				12.00			0.40	0.23				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	6	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					12.00		0.00													51.00						0.00				17.00				17.00			0.57	0.40				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_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					35.00		87.50													135.00						87.50				45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_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					85.00		212.50													285.00						212.50				95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	6	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												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	7	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		0.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	7	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		0.00													60.00						0.00				20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_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					40.00		100.00													141.00						100.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_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					90.00		225.00													300.00						225.00				100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1568.16	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1452.00	25	25	25																		25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	015	0	1	01	01	H1660_015_0	5	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	015	0	1	01	01	H1660_015_0	5	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	015	0	1	01	01	H1660_015_0	5	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	015	0	1	01	01	H1660_015_0	5	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	015	0	1	01	01	H1660_015_0	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1452.00	25	25	25																		25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	016	1	1	01	01	H1660_016_1	5	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	016	1	1	01	01	H1660_016_1	5	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	016	1	1	01	01	H1660_016_1	5	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	016	1	1	01	01	H1660_016_1	5	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	016	1	1	01	01	H1660_016_1	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1510.08	26	26	26																		26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	016	2	1	01	01	H1660_016_2	5	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	016	2	1	01	01	H1660_016_2	5	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	016	2	1	01	01	H1660_016_2	5	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	016	2	1	01	01	H1660_016_2	5	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	016	2	1	01	01	H1660_016_2	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1510.08	26	26	26																		26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	017	1	1	01	01	H1660_017_1	5	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	017	1	1	01	01	H1660_017_1	5	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	017	1	1	01	01	H1660_017_1	5	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	017	1	1	01	01	H1660_017_1	5	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	017	1	1	01	01	H1660_017_1	5	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	017	1	1	01	01	H1660_017_1	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1916.64	33	33	33																		33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	017	2	1	01	01	H1660_017_2	5	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	017	2	1	01	01	H1660_017_2	5	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	017	2	1	01	01	H1660_017_2	5	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	017	2	1	01	01	H1660_017_2	5	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	017	2	1	01	01	H1660_017_2	5	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	017	2	1	01	01	H1660_017_2	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1916.64	33	33	33																		33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1664	001	0	1	01	01	H1664_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								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 Drug, Specialty Tier, Select Care Drugs												
H1664	001	0	1	01	01	H1664_001_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					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 Drug, Specialty Tier, Select Care Drugs												
H1664	001	0	1	01	01	H1664_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					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 Drug, Specialty Tier, Select Care Drugs												
H1664	001	0	1	01	01	H1664_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					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 Drug, Specialty Tier, Select Care Drugs												
H1664	001	0	1	01	01	H1664_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, Select Care Drugs												
H1664	001	0	1	01	01	H1664_001_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 Drug, Specialty Tier, Select Care Drugs												
H1664	002	0	1	01	01	H1664_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								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 Drug, Specialty Tier, Select Care Drugs												
H1664	002	0	1	01	01	H1664_002_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					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 Drug, Specialty Tier, Select Care Drugs												
H1664	002	0	1	01	01	H1664_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					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 Drug, Specialty Tier, Select Care Drugs												
H1664	002	0	1	01	01	H1664_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					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 Drug, Specialty Tier, Select Care Drugs												
H1664	002	0	1	01	01	H1664_002_0	5	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, Select Care Drugs												
H1664	002	0	1	01	01	H1664_002_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 Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_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								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 Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_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					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 Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_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								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 Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_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		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 Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_004_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, Select Care Drugs												
H1664	004	0	1	01	01	H1664_004_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 Drug, Specialty Tier, Select Care Drugs												
H1664	005	0	1	01	01	H1664_005_0	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												
H1664	005	0	1	01	01	H1664_005_0	5	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	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 Drug, Specialty Tier, Select Care Drugs												
H1664	005	0	1	01	01	H1664_005_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																			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												
H1664	005	0	1	01	01	H1664_005_0	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												
H1664	005	0	1	01	01	H1664_005_0	5	Specialty Tier	3	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, Select Care Drugs												
H1664	005	0	1	01	01	H1664_005_0	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												
H1666	001	0	1	04	01	H1666_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													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	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	001	0	1	04	01	H1666_001_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	001	0	1	04	01	H1666_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					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	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	001	0	1	04	01	H1666_001_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					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	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												25		25					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	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												25		25					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	11	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	11	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	11	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	11	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	11	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	11	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					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	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												25		25					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	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												25		25					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	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												25		25					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								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												
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								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		
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	003	0	1	01	01	H1692_003_0	2	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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	2	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	10.00					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		
H1692	003	0	1	01	01	H1692_003_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	004	0	1	01	01	H1692_004_0	2	Preferred Generic	4	01	1	2	1	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												
H1692	004	0	1	01	01	H1692_004_0	2	Preferred Generic	4	01	1	2	1	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		
H1692	004	0	1	01	01	H1692_004_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H1692	004	0	1	01	01	H1692_004_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H1692	004	0	1	01	01	H1692_004_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	004	0	1	01	01	H1692_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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												
H1722	001	0	1	01	01	H1722_001_0	5	Generic	3	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	4.70		14.10																					14.10																4.70				4.70		0.16						0.15	Generic, Brand												
H1722	001	0	1	01	01	H1722_001_0	5	Brand	3	10	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				67.44	25		25																				25															25			25								Generic, Brand												
H1723	001	0	1	48	05	H1723_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	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	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	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	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			
H1737	001	0	1	01	01	H1737_001_0	13	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	13	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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											87.11	50	50	50				84.07	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	13	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	5	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																			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												
H1846	004	0	1	04	01	H1846_004_0	5	Preferred Generic	4	11	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		
H1846	004	0	1	04	01	H1846_004_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																			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	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	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	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	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	5	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	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	11	1	2	6	1		111	01	110		1				30	60	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	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	11	1	2	6	3		111	01	110		1				30	60	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	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	8	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	8	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	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	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								16.00	32.00	48.00					16.00	32.00	48.00					16.00		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	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H1894	002	0	1	01	01	H1894_002_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H1944	001	0	1	01	01	H1944_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				520.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H1944	004	0	1	01	01	H1944_004_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				714.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	005	0	1	01	01	H1944_005_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				656.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	006	0	1	01	01	H1944_006_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1054.00	28		28																										28						28			28			28								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				2	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				2	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				2	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				2	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				2	2						90	30		31				825.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H1944	010	0	1	01	01	H1944_010_0	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1046.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H1944	011	0	1	01	01	H1944_011_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				917.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	014	0	1	01	01	H1944_014_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				678.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	016	0	1	01	01	H1944_016_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				922.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				823.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	018	0	1	01	01	H1944_018_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H1944	018	0	1	01	01	H1944_018_0	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	018	0	1	01	01	H1944_018_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				950.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H1944	019	0	1	01	01	H1944_019_0	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				870.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	020	0	1	01	01	H1944_020_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				869.00	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				2	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	3	2	2	1	110		01		100	1	30		90				2	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	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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
H1944	021	0	1	01	01	H1944_021_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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				2	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				2	2						90	30		31				716.00	31		31																										31						31			31			31								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				2	2						90	30		31	3.00		6.00																											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	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	022	0	1	01	01	H1944_022_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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				2	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				2	2						90	30		31				1140.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				785.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	025	0	1	01	01	H1944_025_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	025	0	1	01	01	H1944_025_0	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										1		3
H1944	025	0	1	01	01	H1944_025_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				900.00	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	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	5	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	5	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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
H1944	028	0	1	01	01	H1944_028_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1063.00	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	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	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	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												33							33												33						33					33			33								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					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	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	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	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	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												33							33												33						33					33			33								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					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	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	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	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	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												
H1951	032	0	1	01	01	H1951_032_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_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												
H1951	033	0	1	01	01	H1951_033_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												
H1951	033	0	1	01	01	H1951_033_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_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												
H1951	034	0	1	01	01	H1951_034_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												
H1951	034	0	1	01	01	H1951_034_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_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												
H1951	038	0	1	01	01	H1951_038_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												
H1951	038	0	1	01	01	H1951_038_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_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												
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					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	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					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	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	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	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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_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												
H1951	041	0	1	01	01	H1951_041_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_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												
H1951	044	0	1	01	01	H1951_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					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	4	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	4	Generic	4	11	3	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	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	4	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H1951	044	0	1	01	01	H1951_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	4	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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_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												
H1951	044	0	1	01	01	H1951_044_0	4	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												17							17												17						17					17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_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												
H1951	044	0	1	01	01	H1951_044_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		
H1951	047	1	1	01	01	H1951_047_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					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	047	1	1	01	01	H1951_047_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	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												
H1951	047	2	1	01	01	H1951_047_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					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	047	2	1	01	01	H1951_047_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_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												
H1951	048	1	1	01	01	H1951_048_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					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	048	1	1	01	01	H1951_048_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	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												
H1951	048	2	1	01	01	H1951_048_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					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	048	2	1	01	01	H1951_048_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_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												
H1951	049	1	1	01	01	H1951_049_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												
H1951	049	1	1	01	01	H1951_049_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_1	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												
H1951	049	2	1	01	01	H1951_049_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												
H1951	049	2	1	01	01	H1951_049_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_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												
H1951	049	3	1	01	01	H1951_049_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												
H1951	049	3	1	01	01	H1951_049_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	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												
H1961	014	1	1	01	01	H1961_014_1	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												
H1961	014	1	1	01	01	H1961_014_1	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		
H1961	014	1	1	01	01	H1961_014_1	5	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	5	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	1	1	01	01	H1961_014_1	5	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																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	5	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	80.00		240.00																					240.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1090.88	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_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												
H1961	014	2	1	01	01	H1961_014_2	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										1		
H1961	014	2	1	01	01	H1961_014_2	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	6	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	2	1	01	01	H1961_014_2	6	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																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_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																					240.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1090.88	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	02	01	H1961_017_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												
H1961	017	0	1	02	01	H1961_017_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										1		
H1961	017	0	1	02	01	H1961_017_0	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	02	01	H1961_017_0	6	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	017	0	1	02	01	H1961_017_0	6	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																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	02	01	H1961_017_0	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																					240.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	02	01	H1961_017_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1251.29	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	002	0	1	01	01	H1969_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								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												
H1969	002	0	1	01	01	H1969_002_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												
H1969	002	0	1	01	01	H1969_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	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												
H1969	002	0	1	01	01	H1969_002_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	002	0	1	01	01	H1969_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1400.70	29						1400.70	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	004	0	1	01	01	H1969_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												
H1969	004	0	1	01	01	H1969_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												
H1969	004	0	1	01	01	H1969_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												
H1969	004	0	1	01	01	H1969_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	004	0	1	01	01	H1969_004_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1593.90	33						1593.90	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1977	001	0	1	48	05	H1977_001_0	8	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	8	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	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				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	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				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	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				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	6	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				849.99	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	100				1	2	30	60	100				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	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				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	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				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	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				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				750.52	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	9	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				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	9	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				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	9	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				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	9	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				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	9	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				779.77	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				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	8	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				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	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				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	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				869.48	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	100				1	2	30	60	100				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	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				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	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				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	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				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				690.24	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	100				1	2	30	60	100				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	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				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										1		
H1994	007	0	1	01	01	H1994_007_0	5	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				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	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				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	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				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				1002.61	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	8	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				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	8	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				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	8	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				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	8	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				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	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				817.09	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	009	0	1	01	01	H1994_009_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				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	009	0	1	01	01	H1994_009_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				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										1		
H1994	009	0	1	01	01	H1994_009_0	7	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	8.00	16.00	24.00																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	009	0	1	01	01	H1994_009_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				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	009	0	1	01	01	H1994_009_0	7	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				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	009	0	1	01	01	H1994_009_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1229.68	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	010	0	1	01	01	H1994_010_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				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	010	0	1	01	01	H1994_010_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				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										1		
H1994	010	0	1	01	01	H1994_010_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	010	0	1	01	01	H1994_010_0	6	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				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	010	0	1	01	01	H1994_010_0	6	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				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	010	0	1	01	01	H1994_010_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1229.68	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	011	0	1	01	01	H1994_011_0	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				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	011	0	1	01	01	H1994_011_0	7	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				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										1		
H1994	011	0	1	01	01	H1994_011_0	7	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	011	0	1	01	01	H1994_011_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				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	011	0	1	01	01	H1994_011_0	7	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				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	011	0	1	01	01	H1994_011_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1229.68	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_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								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												
H1997	002	0	1	01	01	H1997_002_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												
H1997	002	0	1	01	01	H1997_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	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												
H1997	002	0	1	01	01	H1997_002_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1400.70	29						1400.70	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	007	1	1	01	01	H1997_007_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												
H1997	007	1	1	01	01	H1997_007_1	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												
H1997	007	1	1	01	01	H1997_007_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												
H1997	007	1	1	01	01	H1997_007_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	007	1	1	01	01	H1997_007_1	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1304.10	27						1304.10	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	007	2	1	01	01	H1997_007_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												
H1997	007	2	1	01	01	H1997_007_2	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												
H1997	007	2	1	01	01	H1997_007_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												
H1997	007	2	1	01	01	H1997_007_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	007	2	1	01	01	H1997_007_2	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1304.10	27						1304.10	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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				2	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				2	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				2	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				2	2						90	30		31				947.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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
H2001	010	0	1	04	01	H2001_010_0	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				909.00	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				2	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				2	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												
H2001	017	0	1	04	01	H2001_017_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	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												
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				2	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				2	2						100	30		31				980.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2011	001	0	1	01	01	H2011_001_0	11	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		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2011	001	0	1	01	01	H2011_001_0	11	Generic	4	11	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												
H2011	001	0	1	01	01	H2011_001_0	11	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 Drug, Specialty Tier												
H2011	001	0	1	01	01	H2011_001_0	11	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2011	001	0	1	01	01	H2011_001_0	11	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				625.00	31		31																		31		31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2011	002	0	1	01	01	H2011_002_0	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2011	002	0	1	01	01	H2011_002_0	11	Generic	4	11	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												
H2011	002	0	1	01	01	H2011_002_0	11	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 Drug, Specialty Tier												
H2011	002	0	1	01	01	H2011_002_0	11	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2011	002	0	1	01	01	H2011_002_0	11	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				654.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	001	0	1	04	01	H2020_001_0	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	2.00		0.00																			2.00		0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	001	0	1	04	01	H2020_001_0	7	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	2.00		0.00																			2.00		0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2020	001	0	1	04	01	H2020_001_0	7	Generic	4	01	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		16.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	001	0	1	04	01	H2020_001_0	7	Generic	4	01	3	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		16.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2020	001	0	1	04	01	H2020_001_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																			47.00		136.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	001	0	1	04	01	H2020_001_0	7	Non-Preferred Drug	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				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	001	0	1	04	01	H2020_001_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				50.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	002	0	1	04	01	H2020_002_0	7	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		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	002	0	1	04	01	H2020_002_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2020	002	0	1	04	01	H2020_002_0	7	Generic	4	01	3	2	2	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		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	002	0	1	04	01	H2020_002_0	7	Generic	4	01	3	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2020	002	0	1	04	01	H2020_002_0	7	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	42.00		126.00																			42.00		121.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	002	0	1	04	01	H2020_002_0	7	Non-Preferred Drug	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				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	002	0	1	04	01	H2020_002_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				50.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	003	0	1	04	01	H2020_003_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	003	0	1	04	01	H2020_003_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2020	003	0	1	04	01	H2020_003_0	7	Generic	4	01	3	2	2	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		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	003	0	1	04	01	H2020_003_0	7	Generic	4	01	3	2	2	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, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2020	003	0	1	04	01	H2020_003_0	7	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	42.00		126.00																			42.00		121.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	003	0	1	04	01	H2020_003_0	7	Non-Preferred Drug	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				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	003	0	1	04	01	H2020_003_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				50.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	004	0	1	04	01	H2020_004_0	7	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	2.00		0.00																			2.00		0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	004	0	1	04	01	H2020_004_0	7	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	2.00		0.00																			2.00		0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2020	004	0	1	04	01	H2020_004_0	7	Generic	4	01	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		16.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	004	0	1	04	01	H2020_004_0	7	Generic	4	01	3	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		16.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2020	004	0	1	04	01	H2020_004_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																			47.00		136.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	004	0	1	04	01	H2020_004_0	7	Non-Preferred Drug	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				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	004	0	1	04	01	H2020_004_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				50.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	005	0	1	04	01	H2020_005_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	005	0	1	04	01	H2020_005_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2020	005	0	1	04	01	H2020_005_0	7	Generic	4	01	3	2	2	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		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	005	0	1	04	01	H2020_005_0	7	Generic	4	01	3	2	2	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, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2020	005	0	1	04	01	H2020_005_0	7	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	42.00		126.00																			42.00		121.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	005	0	1	04	01	H2020_005_0	7	Non-Preferred Drug	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				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	005	0	1	04	01	H2020_005_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				50.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	5	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	5	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		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		215.00				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2029	001	0	1	04	01	H2029_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												
H2032	001	0	1	04	01	H2032_001_0	5	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	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												
H2032	001	0	1	04	01	H2032_001_0	5	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	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 Drug, Specialty Tier												
H2032	001	0	1	04	01	H2032_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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												
H2032	001	0	1	04	01	H2032_001_0	5	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	198.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	001	0	1	04	01	H2032_001_0	5	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	5	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	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 Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_0	5	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	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 Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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												
H2032	002	0	1	04	01	H2032_002_0	5	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	198.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_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												
H2032	003	0	1	04	01	H2032_003_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				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												
H2032	003	0	1	04	01	H2032_003_0	5	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				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		
H2032	003	0	1	04	01	H2032_003_0	5	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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												
H2032	003	0	1	04	01	H2032_003_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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												
H2032	003	0	1	04	01	H2032_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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												
H2032	003	0	1	04	01	H2032_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												
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				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	5	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	40.00					15.00	30.00	30.00											20.00	40.00	40.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	2	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												
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	2	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				100.00				100.00			3.33	3.17		3.33	3.17	3.23	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											554.52	27						575.03	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_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								9.00	18.00	18.00					4.00	8.00	8.00											9.00	18.00	18.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	4	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	40.00					15.00	30.00	30.00											20.00	40.00	40.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	4	Preferred Brand	4	11	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											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												
H2108	028	0	1	01	01	H2108_028_0	4	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											100.00	200.00	300.00				95.00	190.00	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												
H2108	028	0	1	01	01	H2108_028_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											583.06	27						528.17	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	029	0	1	01	01	H2108_029_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				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	4	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	40.00					15.00	30.00	30.00											20.00	40.00	40.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	4	Preferred Brand	4	11	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											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, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	4	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											100.00	200.00	300.00				95.00	190.00	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, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											498.95	27						425.69	27												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	4	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				5.00	10.00	10.00				6.00				6.00			0.20	0.17		0.20	0.17	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_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								9.00	18.00	18.00					4.00	8.00	8.00											9.00	18.00	18.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	4	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	40.00					15.00	30.00	30.00											20.00	40.00	40.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	4	Preferred Brand	4	11	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											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, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	4	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											100.00	200.00	300.00				95.00	190.00	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, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											567.95	27						493.47	27												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	4	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				10.00	20.00	20.00				11.00				11.00			0.37	0.33		0.37	0.33	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				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	032	0	1	01	01	H2108_032_0	4	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	40.00					15.00	30.00	30.00											20.00	40.00	40.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	2	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												
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	2	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				100.00				100.00			3.33	3.17		3.33	3.17	3.23	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											501.99	26						457.34	26												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				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	033	0	1	01	01	H2108_033_0	4	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	40.00					15.00	30.00	30.00											20.00	40.00	40.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	2	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												
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	2	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				100.00				100.00			3.33	3.17		3.33	3.17	3.23	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											447.80	26						530.33	26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2150	002	0	1	18	06	H2150_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								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	0.00	0.00				10.00				10.00			0.33	0.06		0.33	0.06	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	9	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	0.00	0.00				10.00				10.00			0.33	0.06		0.33	0.06	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	002	0	1	18	06	H2150_002_0	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	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			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	9	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	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			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	002	0	1	18	06	H2150_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	9	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					80.00	160.00	240.00											100.00	200.00	300.00				80.00	160.00	160.00				100.00				100.00			3.33	2.66		3.33	2.66	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	9	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											1898.00	33	33	33				1898.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	9	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	9	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	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					7.00	14.00	21.00											10.00	20.00	30.00				7.00	0.00	0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	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			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	9	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					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	190.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	9	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											1585.00	25	25	25				1585.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	9	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	9	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	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					7.00	14.00	21.00											10.00	20.00	30.00				7.00	0.00	0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	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			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	9	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					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	190.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	9	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											1734.00	25	25	25				1734.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	9	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	9	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	4	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	4	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	13.00	26.00	26.00																			13.00	19.50	19.50																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2161	003	0	1	01	01	H2161_003_0	4	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	4	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	4	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	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		
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	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												
H2171	001	0	1	01	01	H2171_001_0	5	Preferred Brand	4	11	1	2	3	3	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										2	3	
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	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	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	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	7	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	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	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	001	0	1	01	01	H2172_001_0	7	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	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			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	7	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	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			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	001	0	1	01	01	H2172_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	7	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					80.00	160.00	240.00											100.00	200.00	300.00				80.00	160.00	160.00				100.00				100.00			3.33	2.66		3.33	2.66	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											2544.00	33	33	33				2544.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_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	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_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	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	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	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	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	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	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	002	0	1	01	01	H2172_002_0	7	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	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			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	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			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	002	0	1	01	01	H2172_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					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7	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					80.00	160.00	240.00											100.00	200.00	300.00				80.00	160.00	160.00				100.00				100.00			3.33	2.66		3.33	2.66	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											2002.00	33	33	33				2002.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_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												
H2172	002	0	1	01	01	H2172_002_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		
H2172	003	0	1	01	01	H2172_003_0	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	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	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	7	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	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			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_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					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	7	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	200.00	300.00				100.00	200.00	200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											2736.00	33	33	33				2736.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_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	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_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	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	7	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	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	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	01	01	H2172_004_0	7	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	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			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	01	01	H2172_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					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	01	01	H2172_004_0	7	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	200.00	300.00				100.00	200.00	200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	01	01	H2172_004_0	7	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											1564.00	33	33	33				1564.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	01	01	H2172_004_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												
H2172	004	0	1	01	01	H2172_004_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		
H2172	006	0	1	01	01	H2172_006_0	9	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	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	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	9	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	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			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_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					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	9	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	200.00	300.00				100.00	200.00	200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	9	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											1458.00	33	33	33				1458.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	9	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	006	0	1	01	01	H2172_006_0	9	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				923.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				718.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				974.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1009.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				744.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1016.00	29		29																										29						29			29			29								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				2	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				2	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				2	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				2	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				2	2						90	30		31				1044.00	32		32																										32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		28.00																											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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				827.00	26		26																										26						26			26			26								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				2	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				2	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				2	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				2	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				2	2						90	30		31				526.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				769.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		5.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		20.00																											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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				814.00	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				2	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												
H2228	031	0	1	04	01	H2228_031_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H2228	031	0	1	04	01	H2228_031_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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				2	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				2	2						90	30		31				620.00	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				2	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	032	0	1	04	01	H2228_032_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	032	0	1	04	01	H2228_032_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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				2	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				2	2						90	30		31				817.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				834.00	31		31																										31						31			31			31								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				2	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				2	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				2	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				2	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				2	2						90	30		31				762.00	31		31																										31						31			31			31								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				2	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				2	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				2	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				2	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				2	2						90	30		31				927.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				781.00	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	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	5	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						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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				792.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	048	0	1	04	01	H2228_048_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		5.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		20.00																											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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1053.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				946.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	064	0	1	04	01	H2228_064_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	064	0	1	04	01	H2228_064_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	064	0	1	04	01	H2228_064_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	064	0	1	04	01	H2228_064_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				945.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	065	0	1	04	01	H2228_065_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	065	0	1	04	01	H2228_065_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	065	0	1	04	01	H2228_065_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	065	0	1	04	01	H2228_065_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				945.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	066	0	1	04	01	H2228_066_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	066	0	1	04	01	H2228_066_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	066	0	1	04	01	H2228_066_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	066	0	1	04	01	H2228_066_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	066	0	1	04	01	H2228_066_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				945.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	067	0	1	04	01	H2228_067_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	067	0	1	04	01	H2228_067_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	067	0	1	04	01	H2228_067_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	067	0	1	04	01	H2228_067_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				579.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	068	0	1	04	01	H2228_068_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	068	0	1	04	01	H2228_068_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	068	0	1	04	01	H2228_068_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	068	0	1	04	01	H2228_068_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				579.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	071	0	1	04	01	H2228_071_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	071	0	1	04	01	H2228_071_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				868.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2230	002	0	1	04	01	H2230_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								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	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					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	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					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	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					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	5	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	4	Preferred Generic	4	11	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	4	Generic	4	11	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	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	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	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					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	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 Brand, Specialty Tier												
H2230	018	1	1	04	01	H2230_018_1	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	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	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	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	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					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	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					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	5	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	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	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	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	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	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					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	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					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	5	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												
H2235	001	0	1	01	01	H2235_001_0	10	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 Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	10	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					0.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	10	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					95.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	10	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	85.00	170.00	255.00																					245.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1869.36	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_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 Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	8	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																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_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																					125.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_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																					275.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1839.20	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	4	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	001	0	1	01	01	H2237_001_0	4	Brand	3	10	1	2	2	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	Generic, Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	4	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	4	Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	33.00																11.00				11.00		0.37			0.37			0.35	Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	4	Brand	3	10	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	46.00	92.00	138.00																			46.00	92.00	138.00																46.00				46.00		1.53			1.53			1.48	Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	4	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	4	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	4	Brand	3	10	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	46.00	92.00	138.00																			46.00	92.00	138.00																46.00				46.00		1.53			1.53			1.48	Generic, Brand, Specialty Tier												
H2237	009	0	1	01	01	H2237_009_0	4	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	4	Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	33.00																11.00				11.00		0.37			0.37			0.35	Generic, Brand, Specialty Tier												
H2237	010	0	1	01	01	H2237_010_0	4	Brand	3	10	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	46.00	92.00	138.00																			46.00	92.00	138.00																46.00				46.00		1.53			1.53			1.48	Generic, Brand, Specialty Tier												
H2237	010	0	1	01	01	H2237_010_0	4	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	009	0	1	01	01	H2241_009_0	5	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	009	0	1	01	01	H2241_009_0	5	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	009	0	1	01	01	H2241_009_0	5	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	009	0	1	01	01	H2241_009_0	5	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	009	0	1	01	01	H2241_009_0	5	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	009	0	1	01	01	H2241_009_0	5	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	009	0	1	01	01	H2241_009_0	5	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	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												
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	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												
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	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												
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	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												
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	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												
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	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												
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	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												
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	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												
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	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												
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	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	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	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	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	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												
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	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												
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	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												
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	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												
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	5	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					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	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					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	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					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	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					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	5	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	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	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	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	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	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					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	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					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	5	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	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	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	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	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	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					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	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					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	5	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	6	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					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	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	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	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					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	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					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	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	2	1	02	01	H2261_023_2	6	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					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	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	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	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					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	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					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	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	024	0	1	01	01	H2261_024_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	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	024	0	1	01	01	H2261_024_0	5	Generic	4	11	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												
H2261	024	0	1	01	01	H2261_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					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	024	0	1	01	01	H2261_024_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					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	024	0	1	01	01	H2261_024_0	5	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												
H2288	001	0	1	01	01	H2288_001_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2288	001	0	1	01	01	H2288_001_0	9	Generic	4	11	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				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2288	001	0	1	01	01	H2288_001_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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2288	001	0	1	01	01	H2288_001_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2288	001	0	1	01	01	H2288_001_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				627.00	29		29																		29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2288	002	0	1	01	01	H2288_002_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2288	002	0	1	01	01	H2288_002_0	9	Generic	4	11	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												
H2288	002	0	1	01	01	H2288_002_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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2288	002	0	1	01	01	H2288_002_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2288	002	0	1	01	01	H2288_002_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				692.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	14	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	14	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	14	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	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											75.77	45	45	45				67.35	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	14	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	14	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	14	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	14	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	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											64.54	45	45	45				57.37	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	14	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	14	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	14	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	14	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	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											79.92	50	50	50				71.93	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	14	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	14	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	14	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	14	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	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											77.80	50	50	50				70.02	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	14	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	14	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	14	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	14	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	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											65.92	45	45	45				58.59	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	14	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	14	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	14	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	14	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	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											78.26	50	50	50				70.44	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	14	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	14	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	14	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	14	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	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											63.55	45	45	45				56.49	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	14	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	14	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	14	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	14	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	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											74.98	50	50	50				67.48	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	14	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	14	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	14	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	14	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	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											64.04	45	45	45				56.92	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	14	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	14	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	14	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	14	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	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											73.13	50	50	50				65.82	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	14	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	14	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	0.00																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	14	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					15.00	30.00	45.00					15.00	30.00	0.00																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	14	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	022	1	1	02	01	H2320_022_1	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											84.94	50	50	50				76.45	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	14	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												
H2320	022	2	1	02	01	H2320_022_2	14	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	0.00																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	14	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					15.00	30.00	45.00					15.00	30.00	0.00																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	14	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	022	2	1	02	01	H2320_022_2	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											84.94	50	50	50				76.45	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	14	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												
H2320	022	3	1	02	01	H2320_022_3	14	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	0.00																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	14	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					15.00	30.00	45.00					15.00	30.00	0.00																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	14	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	022	3	1	02	01	H2320_022_3	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											84.94	50	50	50				76.45	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	14	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												
H2320	022	4	1	02	01	H2320_022_4	14	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	0.00																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	14	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					15.00	30.00	45.00					15.00	30.00	0.00																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	14	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	022	4	1	02	01	H2320_022_4	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											84.94	50	50	50				76.45	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	14	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												
H2320	022	5	1	02	01	H2320_022_5	14	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	0.00																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	14	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					15.00	30.00	45.00					15.00	30.00	0.00																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	14	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	022	5	1	02	01	H2320_022_5	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											84.94	50	50	50				76.45	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	14	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												
H2322	004	0	1	04	01	H2322_004_0	6	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				0.00	0.00	0.00				7.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	6	Preferred Generic	4	01	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				0.00	0.00	0.00				7.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2322	004	0	1	04	01	H2322_004_0	6	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	6	Generic	4	11	3	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2322	004	0	1	04	01	H2322_004_0	6	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_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											70.02	48	48	48				65.64	45	45	45										48	48	48				45	45	45			48			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_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												
H2322	008	0	1	04	01	H2322_008_0	6	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				0.00	0.00	0.00				7.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	6	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	6	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_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											60.27	48	48	48				56.50	45	45	45										48	48	48				45	45	45			48			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_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												
H2322	011	0	1	04	01	H2322_011_0	6	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				0.00	0.00	0.00				7.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	011	0	1	04	01	H2322_011_0	6	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	011	0	1	04	01	H2322_011_0	6	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	011	0	1	04	01	H2322_011_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											50.63	48	48	48				47.46	45	45	45										48	48	48				45	45	45			48			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	011	0	1	04	01	H2322_011_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												
H2322	012	0	1	04	01	H2322_012_0	6	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				0.00	0.00	0.00				7.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	012	0	1	04	01	H2322_012_0	6	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	012	0	1	04	01	H2322_012_0	6	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	012	0	1	04	01	H2322_012_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											50.34	48	48	48				47.20	45	45	45										48	48	48				45	45	45			48			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	012	0	1	04	01	H2322_012_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												
H2334	001	0	1	04	01	H2334_001_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	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	6	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	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																					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	6	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	6	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				606.21	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	6	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	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												
H2334	003	0	1	04	01	H2334_003_0	7	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	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 Drug, Specialty Tier												
H2334	003	0	1	04	01	H2334_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	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												
H2334	003	0	1	04	01	H2334_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		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												
H2334	003	0	1	04	01	H2334_003_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				655.33	28	28	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	6	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					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	6	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	6	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_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											59.44	48	48	48				55.72	45	45	45										48	48	48				45	45	45			48			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_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												
H2354	018	0	1	01	01	H2354_018_0	7	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					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	018	0	1	01	01	H2354_018_0	7	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	018	0	1	01	01	H2354_018_0	7	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	018	0	1	01	01	H2354_018_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											44.91	48	48	48				42.11	45	45	45										48	48	48				45	45	45			48			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	018	0	1	01	01	H2354_018_0	7	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												
H2354	020	0	1	02	01	H2354_020_0	5	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					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	020	0	1	02	01	H2354_020_0	5	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	020	0	1	02	01	H2354_020_0	5	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	020	0	1	02	01	H2354_020_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											51.06	48	48	48				47.87	45	45	45										48	48	48				45	45	45			48			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	020	0	1	02	01	H2354_020_0	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 Drug, Specialty Tier												
H2354	021	0	1	02	01	H2354_021_0	6	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					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	021	0	1	02	01	H2354_021_0	6	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	021	0	1	02	01	H2354_021_0	6	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	021	0	1	02	01	H2354_021_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											60.83	48	48	48				57.03	45	45	45										48	48	48				45	45	45			48			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	021	0	1	02	01	H2354_021_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												
H2354	022	0	1	02	01	H2354_022_0	6	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					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	022	0	1	02	01	H2354_022_0	6	Preferred Generic	4	01	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2354	022	0	1	02	01	H2354_022_0	6	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	022	0	1	02	01	H2354_022_0	6	Generic	4	11	3	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2354	022	0	1	02	01	H2354_022_0	6	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	022	0	1	02	01	H2354_022_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											44.08	48	48	48				41.33	45	45	45										48	48	48				45	45	45			48			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	022	0	1	02	01	H2354_022_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												
H2354	024	0	1	01	01	H2354_024_0	6	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					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	024	0	1	01	01	H2354_024_0	6	Preferred Generic	4	01	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2354	024	0	1	01	01	H2354_024_0	6	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	024	0	1	01	01	H2354_024_0	6	Generic	4	11	3	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		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				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2354	024	0	1	01	01	H2354_024_0	6	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		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				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	024	0	1	01	01	H2354_024_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											50.09	48	48	48				46.95	45	45	45										48	48	48				45	45	45			48			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	024	0	1	01	01	H2354_024_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												
H2406	008	0	1	04	01	H2406_008_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				917.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				917.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				917.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				897.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	012	0	1	04	01	H2406_012_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	012	0	1	04	01	H2406_012_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	012	0	1	04	01	H2406_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	012	0	1	04	01	H2406_012_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				917.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	013	0	1	04	01	H2406_013_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	013	0	1	04	01	H2406_013_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	013	0	1	04	01	H2406_013_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	013	0	1	04	01	H2406_013_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				869.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	014	0	1	04	01	H2406_014_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	014	0	1	04	01	H2406_014_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	014	0	1	04	01	H2406_014_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	014	0	1	04	01	H2406_014_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				889.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	015	0	1	04	01	H2406_015_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	015	0	1	04	01	H2406_015_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	015	0	1	04	01	H2406_015_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	015	0	1	04	01	H2406_015_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				870.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	016	0	1	04	01	H2406_016_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	016	0	1	04	01	H2406_016_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	016	0	1	04	01	H2406_016_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	016	0	1	04	01	H2406_016_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1298.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	017	0	1	04	01	H2406_017_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	017	0	1	04	01	H2406_017_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	017	0	1	04	01	H2406_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	017	0	1	04	01	H2406_017_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				917.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	018	0	1	04	01	H2406_018_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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												
H2406	018	0	1	04	01	H2406_018_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H2406	018	0	1	04	01	H2406_018_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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												
H2406	018	0	1	04	01	H2406_018_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				664.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	019	0	1	04	01	H2406_019_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	019	0	1	04	01	H2406_019_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	019	0	1	04	01	H2406_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	019	0	1	04	01	H2406_019_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				917.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	020	0	1	04	01	H2406_020_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	020	0	1	04	01	H2406_020_0	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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												
H2406	020	0	1	04	01	H2406_020_0	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H2406	020	0	1	04	01	H2406_020_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	020	0	1	04	01	H2406_020_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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												
H2406	020	0	1	04	01	H2406_020_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				679.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2446	001	0	1	02	01	H2446_001_0	10	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	5.00	10.00	15.00																			5.00	0.00	0.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2446	001	0	1	02	01	H2446_001_0	10	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2446	001	0	1	02	01	H2446_001_0	10	Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				18.02	20	20	20																		20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2446	001	0	1	02	01	H2446_001_0	10	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				56.25	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2446	001	0	1	02	01	H2446_001_0	10	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2446	001	0	1	02	01	H2446_001_0	10	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			5.00	0.00	0.00																0.00				0.00		0.00			0.16			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2446	002	0	1	02	01	H2446_002_0	10	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	4.00	8.00	12.00																			4.00	0.00	0.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2446	002	0	1	02	01	H2446_002_0	10	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, Select Care Drugs												
H2446	002	0	1	02	01	H2446_002_0	10	Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				19.91	20	20	20																		20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2446	002	0	1	02	01	H2446_002_0	10	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				50.82	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2446	002	0	1	02	01	H2446_002_0	10	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2446	002	0	1	02	01	H2446_002_0	10	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			4.00	0.00	0.00																0.00				0.00		0.00			0.13			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2450	001	0	1	18	06	H2450_001_0	4	Preferred Generic	4	11	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	4	Generic	4	11	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				65.94	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	4	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	4	Preferred Generic	4	11	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	4	Generic	4	11	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				62.73	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	4	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	11	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	11	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				84.52	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	4	Preferred Generic	3	11	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	4	Generic	3	11	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	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	016	0	1	18	06	H2450_016_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				94.25	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	4	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					26		26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	4	Preferred Generic	3	11	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	4	Generic	3	11	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	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	017	0	1	18	06	H2450_017_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				83.44	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	4	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	4	Preferred Generic	3	11	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	4	Generic	3	11	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	4	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	4	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				107.05	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	4	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					26		26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_0	4	Preferred Generic	3	11	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	4	Generic	3	11	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	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	035	0	1	18	06	H2450_035_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				79.22	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_0	4	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					26		26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	037	0	1	18	06	H2450_037_0	4	Preferred Generic	3	11	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	4	Generic	3	11	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	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	037	0	1	18	06	H2450_037_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				55.61	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	037	0	1	18	06	H2450_037_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	039	0	1	18	06	H2450_039_0	4	Preferred Generic	3	11	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	4	Generic	3	11	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	4	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	039	0	1	18	06	H2450_039_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				72.61	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	039	0	1	18	06	H2450_039_0	4	Specialty Tier	3	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					26		26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	041	0	1	18	06	H2450_041_0	5	Preferred Generic	3	11	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	5	Generic	3	11	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	5	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	041	0	1	18	06	H2450_041_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				76.29	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	041	0	1	18	06	H2450_041_0	5	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	020	0	1	02	01	H2459_020_0	5	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					3.00		9.00											12.00		24.00				3.00		6.00					12.00			12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	020	0	1	02	01	H2459_020_0	5	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	020	0	1	02	01	H2459_020_0	5	Preferred Brand	4	10	1	1	3	1		110	10		110	1				30		90	1	2				30		90		29	31											87.02	25		25				59.17	17		17										25		25				17		17				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	020	0	1	02	01	H2459_020_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											48.70	50		50				43.83	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	020	0	1	02	01	H2459_020_0	5	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1874.99	25		25				1874.99	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	1	1	02	01	H2459_021_1	6	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	6	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	6	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	6	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	6	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	6	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											79.72	50		50				71.75	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	1	1	02	01	H2459_021_1	6	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2339.70	29		29				2339.70	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	4	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	4	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	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											79.72	50		50				71.75	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	2	1	02	01	H2459_021_2	4	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2339.70	29		29				2339.70	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	4	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	4	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	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											79.72	50		50				71.75	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	3	1	02	01	H2459_021_3	4	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2339.70	29		29				2339.70	29		29										29		29				29		29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	6	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					2.00		6.00											12.00		24.00				2.00		4.00					12.00			12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	6	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	6	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					40.00		120.00											47.00		94.00				40.00		80.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	6	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											63.11	50		50				56.80	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	6	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1606.36	25		25				1606.36	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	6	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					2.00		6.00											12.00		24.00				2.00		4.00					12.00			12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	6	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	6	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					40.00		120.00											47.00		94.00				40.00		80.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	6	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											63.11	50		50				56.80	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	6	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1606.36	25		25				1606.36	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	7	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					3.00		9.00											12.00		24.00				3.00		6.00					12.00			12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	7	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	7	Preferred Brand	4	10	1	1	3	1		110	10		110	1				30		90	1	2				30		90		29	31											85.87	25		25				58.39	17		17										25		25				17		17				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											63.11	50		50				56.80	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	7	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1606.36	25		25				1606.36	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	025	1	1	02	01	H2459_025_1	5	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	025	1	1	02	01	H2459_025_1	5	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	025	1	1	02	01	H2459_025_1	5	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	025	1	1	02	01	H2459_025_1	5	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	025	1	1	02	01	H2459_025_1	5	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	025	1	1	02	01	H2459_025_1	5	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											89.54	50		50				80.59	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	025	1	1	02	01	H2459_025_1	5	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2595.11	33		33				2595.11	33		33										33		33				33		33				33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	025	2	1	02	01	H2459_025_2	5	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	025	2	1	02	01	H2459_025_2	5	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	025	2	1	02	01	H2459_025_2	5	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	025	2	1	02	01	H2459_025_2	5	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	025	2	1	02	01	H2459_025_2	5	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	025	2	1	02	01	H2459_025_2	5	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											89.54	50		50				80.59	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	025	2	1	02	01	H2459_025_2	5	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2595.11	33		33				2595.11	33		33										33		33				33		33				33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	025	3	1	02	01	H2459_025_3	5	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	025	3	1	02	01	H2459_025_3	5	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	025	3	1	02	01	H2459_025_3	5	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	025	3	1	02	01	H2459_025_3	5	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	025	3	1	02	01	H2459_025_3	5	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	025	3	1	02	01	H2459_025_3	5	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											89.54	50		50				80.59	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	025	3	1	02	01	H2459_025_3	5	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2595.11	33		33				2595.11	33		33										33		33				33		33				33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	1	1	02	01	H2459_026_1	6	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					3.00		9.00											12.00		24.00				3.00		6.00					12.00			12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	1	1	02	01	H2459_026_1	6	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	1	1	02	01	H2459_026_1	6	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					40.00		120.00											47.00		94.00				40.00		80.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	1	1	02	01	H2459_026_1	6	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											68.20	50		50				61.38	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	1	1	02	01	H2459_026_1	6	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2146.30	29		29				2146.30	29		29										29		29				29		29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	5	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					3.00		9.00											12.00		24.00				3.00		6.00					12.00			12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	5	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		40.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	5	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					40.00		120.00											47.00		94.00				40.00		80.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	5	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											68.20	50		50				61.38	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	5	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2146.30	29		29				2146.30	29		29										29		29				29		29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	008	0	1	18	06	H2461_008_0	9	Preferred Generic	2	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								13.00	26.00	26.00					6.00	12.00	12.00					6.00	0.00	0.00																13.00				13.00			0.42	0.19	0.19			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	9	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 Drug, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	9	Preferred Brand	2	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											20.85	22	22	22				15.47	17	17	17				17	17	17															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	9	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											41.63	50	50	50				35.58	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	9	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 Drug, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	9	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					6.00	0.00	0.00																5.00				5.00			0.16	0.00	0.19			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	10	Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											27.92	25	25	25				21.49	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											49.44	50	50	50				42.56	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	10	Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											23.84	20	20	20				17.24	15	15	15				15	15	15															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											49.02	50	50	50				42.22	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H2462	017	0	1	18	06	H2462_017_0	8	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		4.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2462	017	0	1	18	06	H2462_017_0	8	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		24.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2462	017	0	1	18	06	H2462_017_0	8	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	8	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.75	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	8	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31				1000.14	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	8	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		6.00				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	8	Generic	3	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												
H2462	019	0	1	18	06	H2462_019_0	8	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	019	0	1	18	06	H2462_019_0	8	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.23	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	3	11	1	1	5	1	010		01		010	1	30											30			30		31				976.19	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	4	Preferred Generic	4	11	3	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												
H2463	001	0	1	01	01	H2463_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_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												
H2463	002	0	1	01	01	H2463_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					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												
H2463	002	0	1	01	01	H2463_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	002	0	1	01	01	H2463_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	002	0	1	01	01	H2463_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	002	0	1	01	01	H2463_002_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												
H2486	003	0	1	01	01	H2486_003_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_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												
H2491	004	0	1	01	01	H2491_004_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	3	Generic	3	11	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		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_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		92.00				46.00				46.00		1.53				1.53	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.27	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	3	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												
H2491	006	0	1	01	01	H2491_006_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	006	0	1	01	01	H2491_006_0	4	Generic	3	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	006	0	1	01	01	H2491_006_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		94.00				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	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				79.24	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	4	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												
H2491	007	0	1	01	01	H2491_007_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	007	0	1	01	01	H2491_007_0	5	Generic	4	11	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		0.00				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	5	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												
H2491	007	0	1	01	01	H2491_007_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				72.27	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	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												
H2491	008	0	1	01	01	H2491_008_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	008	0	1	01	01	H2491_008_0	4	Generic	3	11	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		0.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	008	0	1	01	01	H2491_008_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		94.00				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	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				79.34	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	4	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												
H2491	009	0	1	01	01	H2491_009_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	009	0	1	01	01	H2491_009_0	5	Generic	4	11	3	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		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	009	0	1	01	01	H2491_009_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																									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												
H2491	009	0	1	01	01	H2491_009_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				72.48	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	009	0	1	01	01	H2491_009_0	5	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												
H2491	010	0	1	01	01	H2491_010_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	010	0	1	01	01	H2491_010_0	5	Generic	4	11	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		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	010	0	1	01	01	H2491_010_0	5	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												
H2491	010	0	1	01	01	H2491_010_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				80.64	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	010	0	1	01	01	H2491_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												
H2506	001	0	1	48	05	H2506_001_0	4	Generic Drugs	4	11			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	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			
H2506	001	0	1	48	05	H2506_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			
H2531	001	0	1	48	05	H2531_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	0.00	3.40	0.00	3.40	0.00	3.40	0.00	3.40			
H2531	001	0	1	48	05	H2531_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	0.00	8.50	0.00	8.50	0.00	8.50	0.00	8.50			
H2531	001	0	1	48	05	H2531_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																																														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	2	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	2	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	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	2	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	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												
H2563	003	0	1	01	01	H2563_003_0	8	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	003	0	1	01	01	H2563_003_0	8	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	8	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	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				675.29	27		27																				27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	1	1	01	01	H2563_005_1	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												
H2563	005	1	1	01	01	H2563_005_1	8	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	8	Preferred Brand	4	10	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												
H2563	005	1	1	01	01	H2563_005_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																					225.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	1	1	01	01	H2563_005_1	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				692.17	28		28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	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												
H2563	005	2	1	01	01	H2563_005_2	8	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	8	Preferred Brand	4	10	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												
H2563	005	2	1	01	01	H2563_005_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																					225.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				692.17	28		28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2593	001	0	1	01	01	H2593_001_0	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	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, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	8	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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	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							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	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							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	8	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	8	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	8	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	8	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	8	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	8	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	8	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	10	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	10	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	10	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	10	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	10	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	10	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	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												
H2593	019	0	1	01	01	H2593_019_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		
H2593	019	0	1	01	01	H2593_019_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		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	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		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	7	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	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												
H2593	019	0	1	01	01	H2593_019_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												
H2593	019	0	1	01	01	H2593_019_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												
H2593	019	0	1	01	01	H2593_019_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										2	3	
H2593	021	0	1	01	01	H2593_021_0	8	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	021	0	1	01	01	H2593_021_0	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								3.00	6.00	9.00					3.00	6.00	9.00					3.00		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												
H2593	021	0	1	01	01	H2593_021_0	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	021	0	1	01	01	H2593_021_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	021	0	1	01	01	H2593_021_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												
H2593	021	0	1	01	01	H2593_021_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	021	0	1	01	01	H2593_021_0	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	022	0	1	01	01	H2593_022_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00		0.00																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												
H2593	022	0	1	01	01	H2593_022_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00		16.00																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												
H2593	022	0	1	01	01	H2593_022_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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												
H2593	022	0	1	01	01	H2593_022_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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												
H2593	022	0	1	01	01	H2593_022_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												
H2593	022	0	1	01	01	H2593_022_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	022	0	1	01	01	H2593_022_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	023	0	1	01	01	H2593_023_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00		0.00																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												
H2593	023	0	1	01	01	H2593_023_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00		16.00																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												
H2593	023	0	1	01	01	H2593_023_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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												
H2593	023	0	1	01	01	H2593_023_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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												
H2593	023	0	1	01	01	H2593_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												
H2593	023	0	1	01	01	H2593_023_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	023	0	1	01	01	H2593_023_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	024	0	1	01	01	H2593_024_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								5.00	10.00	15.00					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												
H2593	024	0	1	01	01	H2593_024_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																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												
H2593	024	0	1	01	01	H2593_024_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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												
H2593	024	0	1	01	01	H2593_024_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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												
H2593	024	0	1	01	01	H2593_024_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												
H2593	024	0	1	01	01	H2593_024_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	024	0	1	01	01	H2593_024_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	025	0	1	01	01	H2593_025_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	025	0	1	01	01	H2593_025_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00		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												
H2593	025	0	1	01	01	H2593_025_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	025	0	1	01	01	H2593_025_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	025	0	1	01	01	H2593_025_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												
H2593	025	0	1	01	01	H2593_025_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	025	0	1	01	01	H2593_025_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	026	0	1	01	01	H2593_026_0	11	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		6.00																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												
H2593	026	0	1	01	01	H2593_026_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		20.00																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												
H2593	026	0	1	01	01	H2593_026_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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												
H2593	026	0	1	01	01	H2593_026_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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												
H2593	026	0	1	01	01	H2593_026_0	11	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												
H2593	026	0	1	01	01	H2593_026_0	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	026	0	1	01	01	H2593_026_0	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	027	0	1	01	01	H2593_027_0	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		6.00																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												
H2593	027	0	1	01	01	H2593_027_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		20.00																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												
H2593	027	0	1	01	01	H2593_027_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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												
H2593	027	0	1	01	01	H2593_027_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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												
H2593	027	0	1	01	01	H2593_027_0	11	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												
H2593	027	0	1	01	01	H2593_027_0	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	027	0	1	01	01	H2593_027_0	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	028	1	1	01	01	H2593_028_1	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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												
H2593	028	1	1	01	01	H2593_028_1	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00		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												
H2593	028	1	1	01	01	H2593_028_1	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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												
H2593	028	1	1	01	01	H2593_028_1	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	028	1	1	01	01	H2593_028_1	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												
H2593	028	1	1	01	01	H2593_028_1	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	1	1	01	01	H2593_028_1	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	028	2	1	01	01	H2593_028_2	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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												
H2593	028	2	1	01	01	H2593_028_2	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00		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												
H2593	028	2	1	01	01	H2593_028_2	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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												
H2593	028	2	1	01	01	H2593_028_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	028	2	1	01	01	H2593_028_2	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												
H2593	028	2	1	01	01	H2593_028_2	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	2	1	01	01	H2593_028_2	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	028	3	1	01	01	H2593_028_3	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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												
H2593	028	3	1	01	01	H2593_028_3	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00		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												
H2593	028	3	1	01	01	H2593_028_3	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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												
H2593	028	3	1	01	01	H2593_028_3	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	028	3	1	01	01	H2593_028_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												
H2593	028	3	1	01	01	H2593_028_3	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	3	1	01	01	H2593_028_3	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	028	4	1	01	01	H2593_028_4	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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												
H2593	028	4	1	01	01	H2593_028_4	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00		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												
H2593	028	4	1	01	01	H2593_028_4	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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												
H2593	028	4	1	01	01	H2593_028_4	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	028	4	1	01	01	H2593_028_4	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												
H2593	028	4	1	01	01	H2593_028_4	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	4	1	01	01	H2593_028_4	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	028	5	1	01	01	H2593_028_5	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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												
H2593	028	5	1	01	01	H2593_028_5	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00		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												
H2593	028	5	1	01	01	H2593_028_5	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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												
H2593	028	5	1	01	01	H2593_028_5	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	028	5	1	01	01	H2593_028_5	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												
H2593	028	5	1	01	01	H2593_028_5	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	5	1	01	01	H2593_028_5	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	028	6	1	01	01	H2593_028_6	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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												
H2593	028	6	1	01	01	H2593_028_6	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00		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												
H2593	028	6	1	01	01	H2593_028_6	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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												
H2593	028	6	1	01	01	H2593_028_6	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	028	6	1	01	01	H2593_028_6	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												
H2593	028	6	1	01	01	H2593_028_6	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	6	1	01	01	H2593_028_6	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	029	0	1	01	01	H2593_029_0	11	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		6.00																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												
H2593	029	0	1	01	01	H2593_029_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		20.00																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												
H2593	029	0	1	01	01	H2593_029_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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												
H2593	029	0	1	01	01	H2593_029_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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												
H2593	029	0	1	01	01	H2593_029_0	11	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												
H2593	029	0	1	01	01	H2593_029_0	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	030	1	1	01	01	H2593_030_1	8	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	1	1	01	01	H2593_030_1	8	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	030	1	1	01	01	H2593_030_1	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00		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												
H2593	030	1	1	01	01	H2593_030_1	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	030	1	1	01	01	H2593_030_1	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	030	1	1	01	01	H2593_030_1	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												
H2593	030	1	1	01	01	H2593_030_1	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	1	1	01	01	H2593_030_1	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	030	2	1	01	01	H2593_030_2	8	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	2	1	01	01	H2593_030_2	8	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	030	2	1	01	01	H2593_030_2	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00		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												
H2593	030	2	1	01	01	H2593_030_2	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	030	2	1	01	01	H2593_030_2	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	030	2	1	01	01	H2593_030_2	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												
H2593	030	2	1	01	01	H2593_030_2	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	2	1	01	01	H2593_030_2	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	030	3	1	01	01	H2593_030_3	8	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	3	1	01	01	H2593_030_3	8	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	030	3	1	01	01	H2593_030_3	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00		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												
H2593	030	3	1	01	01	H2593_030_3	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	030	3	1	01	01	H2593_030_3	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	030	3	1	01	01	H2593_030_3	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												
H2593	030	3	1	01	01	H2593_030_3	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	3	1	01	01	H2593_030_3	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	030	4	1	01	01	H2593_030_4	8	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	4	1	01	01	H2593_030_4	8	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	030	4	1	01	01	H2593_030_4	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00		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												
H2593	030	4	1	01	01	H2593_030_4	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	030	4	1	01	01	H2593_030_4	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	030	4	1	01	01	H2593_030_4	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												
H2593	030	4	1	01	01	H2593_030_4	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	4	1	01	01	H2593_030_4	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	030	5	1	01	01	H2593_030_5	8	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	5	1	01	01	H2593_030_5	8	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	030	5	1	01	01	H2593_030_5	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00		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												
H2593	030	5	1	01	01	H2593_030_5	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	030	5	1	01	01	H2593_030_5	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	030	5	1	01	01	H2593_030_5	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												
H2593	030	5	1	01	01	H2593_030_5	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	5	1	01	01	H2593_030_5	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	030	6	1	01	01	H2593_030_6	8	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	6	1	01	01	H2593_030_6	8	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	030	6	1	01	01	H2593_030_6	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00		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												
H2593	030	6	1	01	01	H2593_030_6	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	030	6	1	01	01	H2593_030_6	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	030	6	1	01	01	H2593_030_6	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												
H2593	030	6	1	01	01	H2593_030_6	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	6	1	01	01	H2593_030_6	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	031	0	1	02	01	H2593_031_0	9	Preferred Generic	3	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00		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												
H2593	031	0	1	02	01	H2593_031_0	9	Generic	3	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00		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												
H2593	031	0	1	02	01	H2593_031_0	9	Preferred Brand	3	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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												
H2593	031	0	1	02	01	H2593_031_0	9	Non-Preferred Drug	3	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								98.00	196.00	294.00					93.00	186.00	279.00					93.00		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												
H2593	031	0	1	02	01	H2593_031_0	9	Specialty Tier	3	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												
H2593	031	0	1	02	01	H2593_031_0	9	Select Care Drugs	3	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	9	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	9	Preferred Generic	4	01	3	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	032	0	1	01	01	H2593_032_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00		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												
H2593	032	0	1	01	01	H2593_032_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	032	0	1	01	01	H2593_032_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	032	0	1	01	01	H2593_032_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												
H2593	032	0	1	01	01	H2593_032_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	033	0	1	01	01	H2593_033_0	12	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	033	0	1	01	01	H2593_033_0	12	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	033	0	1	01	01	H2593_033_0	12	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00		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												
H2593	033	0	1	01	01	H2593_033_0	12	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	033	0	1	01	01	H2593_033_0	12	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	033	0	1	01	01	H2593_033_0	12	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												
H2593	033	0	1	01	01	H2593_033_0	12	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	033	0	1	01	01	H2593_033_0	12	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	034	0	1	01	01	H2593_034_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	034	0	1	01	01	H2593_034_0	9	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	034	0	1	01	01	H2593_034_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00		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												
H2593	034	0	1	01	01	H2593_034_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	034	0	1	01	01	H2593_034_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	034	0	1	01	01	H2593_034_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												
H2593	034	0	1	01	01	H2593_034_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	034	0	1	01	01	H2593_034_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	035	0	1	01	01	H2593_035_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	035	0	1	01	01	H2593_035_0	9	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	035	0	1	01	01	H2593_035_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00		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												
H2593	035	0	1	01	01	H2593_035_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	035	0	1	01	01	H2593_035_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	035	0	1	01	01	H2593_035_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												
H2593	035	0	1	01	01	H2593_035_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	035	0	1	01	01	H2593_035_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	036	0	1	01	01	H2593_036_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	036	0	1	01	01	H2593_036_0	9	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	036	0	1	01	01	H2593_036_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00		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												
H2593	036	0	1	01	01	H2593_036_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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												
H2593	036	0	1	01	01	H2593_036_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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												
H2593	036	0	1	01	01	H2593_036_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												
H2593	036	0	1	01	01	H2593_036_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	036	0	1	01	01	H2593_036_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	037	0	1	01	01	H2593_037_0	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																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												
H2593	037	0	1	01	01	H2593_037_0	10	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																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										1		
H2593	037	0	1	01	01	H2593_037_0	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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												
H2593	037	0	1	01	01	H2593_037_0	10	Generic	4	01	1	2	2	3		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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										1		
H2593	037	0	1	01	01	H2593_037_0	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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												
H2593	037	0	1	01	01	H2593_037_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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												
H2593	037	0	1	01	01	H2593_037_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												
H2593	037	0	1	01	01	H2593_037_0	10	Select Care Drugs	4	11	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	10	Select Care Drugs	4	11	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	038	0	1	01	01	H2593_038_0	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																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												
H2593	038	0	1	01	01	H2593_038_0	10	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																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										1		
H2593	038	0	1	01	01	H2593_038_0	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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												
H2593	038	0	1	01	01	H2593_038_0	10	Generic	4	01	1	2	2	3		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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										1		
H2593	038	0	1	01	01	H2593_038_0	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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												
H2593	038	0	1	01	01	H2593_038_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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												
H2593	038	0	1	01	01	H2593_038_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												
H2593	038	0	1	01	01	H2593_038_0	10	Select Care Drugs	4	11	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	10	Select Care Drugs	4	11	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	039	0	1	01	01	H2593_039_0	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																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												
H2593	039	0	1	01	01	H2593_039_0	10	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																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										1		
H2593	039	0	1	01	01	H2593_039_0	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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												
H2593	039	0	1	01	01	H2593_039_0	10	Generic	4	01	1	2	2	3		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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										1		
H2593	039	0	1	01	01	H2593_039_0	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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												
H2593	039	0	1	01	01	H2593_039_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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												
H2593	039	0	1	01	01	H2593_039_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												
H2593	039	0	1	01	01	H2593_039_0	10	Select Care Drugs	4	11	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	10	Select Care Drugs	4	11	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2610	005	0	1	01	01	H2610_005_0	7	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	7	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	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					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	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					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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1740.00	33						1740.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	7	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	7	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1910.09	33						1910.09	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	6	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	6	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	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					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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1572.28	33						1572.28	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	015	0	1	01	01	H2610_015_0	6	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																					0.00																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	6	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																					0.00																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	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																					117.50																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	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																					250.00																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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1433.92	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	016	0	1	01	01	H2610_016_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	016	0	1	01	01	H2610_016_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	016	0	1	01	01	H2610_016_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	016	0	1	01	01	H2610_016_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	016	0	1	01	01	H2610_016_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1740.00	33						1740.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	2	Preferred Generic	4	01	1	2	1	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												
H2663	002	0	1	01	01	H2663_002_0	2	Preferred Generic	4	01	1	2	1	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		
H2663	002	0	1	01	01	H2663_002_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H2663	002	0	1	01	01	H2663_002_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H2663	002	0	1	01	01	H2663_002_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	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	2	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	2	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	0.00																			7.00	14.00	0.00																	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	2	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	0.00																			7.00	14.00	0.00																	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	2	Preferred Brand	4	11	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	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	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	2	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	0.00																			7.00	14.00	0.00																	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	0.00																			7.00	14.00	0.00																	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	3	Preferred Generic	4	01	1	2	1	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												
H2663	015	0	1	02	01	H2663_015_0	3	Preferred Generic	4	01	1	2	1	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		
H2663	015	0	1	02	01	H2663_015_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H2663	015	0	1	02	01	H2663_015_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H2663	015	0	1	02	01	H2663_015_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_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	015	0	1	02	01	H2663_015_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	016	0	1	01	01	H2663_016_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	016	0	1	01	01	H2663_016_0	2	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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	2	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	10.00					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		
H2663	016	0	1	01	01	H2663_016_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	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	017	0	1	01	01	H2663_017_0	2	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	017	0	1	01	01	H2663_017_0	2	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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	2	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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	017	0	1	01	01	H2663_017_0	2	Preferred Brand	4	11	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	017	0	1	01	01	H2663_017_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	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	017	0	1	01	01	H2663_017_0	2	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	021	0	1	01	01	H2663_021_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	021	0	1	01	01	H2663_021_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	021	0	1	01	01	H2663_021_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	0.00																			7.00	14.00	0.00																	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	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	0.00																			7.00	14.00	0.00																	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	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	021	0	1	01	01	H2663_021_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	021	0	1	01	01	H2663_021_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	023	0	1	02	01	H2663_023_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	023	0	1	02	01	H2663_023_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	023	0	1	02	01	H2663_023_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	0.00																			7.00	14.00	0.00																	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	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	0.00																			7.00	14.00	0.00																	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	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	023	0	1	02	01	H2663_023_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	023	0	1	02	01	H2663_023_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	024	0	1	02	01	H2663_024_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	024	0	1	02	01	H2663_024_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	024	0	1	02	01	H2663_024_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	0.00																			7.00	14.00	0.00																	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	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	0.00																			7.00	14.00	0.00																	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	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	024	0	1	02	01	H2663_024_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	024	0	1	02	01	H2663_024_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	026	0	1	01	01	H2663_026_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	026	0	1	01	01	H2663_026_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	026	0	1	01	01	H2663_026_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	0.00																			7.00	14.00	0.00																	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	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	0.00																			7.00	14.00	0.00																	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	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	026	0	1	01	01	H2663_026_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	026	0	1	01	01	H2663_026_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	027	0	1	01	01	H2663_027_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	027	0	1	01	01	H2663_027_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	027	0	1	01	01	H2663_027_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	0.00																			7.00	14.00	0.00																	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	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	0.00																			7.00	14.00	0.00																	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	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	027	0	1	01	01	H2663_027_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	027	0	1	01	01	H2663_027_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	028	0	1	01	01	H2663_028_0	2	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	2	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	2	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	0.00																			7.00	14.00	0.00																	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	2	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	0.00																			7.00	14.00	0.00																	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	2	Preferred Brand	4	11	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	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	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	2	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	2	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	2	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	2	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	0.00																			7.00	14.00	0.00																	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	2	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	0.00																			7.00	14.00	0.00																	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	2	Preferred Brand	4	11	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	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	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	2	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	032	0	1	01	01	H2663_032_0	2	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	032	0	1	01	01	H2663_032_0	2	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	032	0	1	01	01	H2663_032_0	2	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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	032	0	1	01	01	H2663_032_0	2	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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	032	0	1	01	01	H2663_032_0	2	Preferred Brand	4	11	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	032	0	1	01	01	H2663_032_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	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	032	0	1	01	01	H2663_032_0	2	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												
H2758	002	0	1	01	01	H2758_002_0	3	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	3	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	3	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	3	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	3	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	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												
H2758	002	0	1	01	01	H2758_002_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								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	3	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	4	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	4	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	4	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	4	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	4	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	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												
H2758	004	0	1	01	01	H2758_004_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								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	4	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	3	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	3	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	3	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	3	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	3	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	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												
H2758	006	0	1	01	01	H2758_006_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								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	3	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	4	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	4	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	4	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	4	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	4	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	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												
H2758	008	0	1	02	01	H2758_008_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								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	4	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	7	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	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		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	7	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	7	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	7	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	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												
H2773	017	0	1	01	01	H2773_017_0	5	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	5	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	5	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	5	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	5	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	5	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	4	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	4	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	4	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	11.50		11.50																			11.50		11.50																11.50				11.50		0.37			.37			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	4	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	4	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	4	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	5	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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								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	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H2775	082	0	1	04	01	H2775_082_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		25.00					5.00		12.50											10.00		25.00				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												
H2775	082	0	1	04	01	H2775_082_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								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	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_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												
H2775	099	0	1	04	01	H2775_099_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_0	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								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	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H2775	099	0	1	04	01	H2775_099_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		25.00					5.00		12.50											10.00		25.00				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												
H2775	099	0	1	04	01	H2775_099_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								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	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_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												
H2775	100	0	1	04	01	H2775_100_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					2.00		5.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					2.00		5.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2775	100	0	1	04	01	H2775_100_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					7.00		17.50											12.00		30.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_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		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	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_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												
H2775	101	1	1	04	01	H2775_101_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					2.00		5.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	101	1	1	04	01	H2775_101_1	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					2.00		5.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2775	101	1	1	04	01	H2775_101_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					7.00		17.50											12.00		30.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	101	1	1	04	01	H2775_101_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	101	1	1	04	01	H2775_101_1	4	Non-Preferred Drug	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											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	101	1	1	04	01	H2775_101_1	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												
H2775	101	2	1	04	01	H2775_101_2	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					2.00		5.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	101	2	1	04	01	H2775_101_2	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					2.00		5.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2775	101	2	1	04	01	H2775_101_2	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					7.00		17.50											12.00		30.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	101	2	1	04	01	H2775_101_2	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	101	2	1	04	01	H2775_101_2	4	Non-Preferred Drug	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											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	101	2	1	04	01	H2775_101_2	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												
H2775	101	3	1	04	01	H2775_101_3	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					2.00		5.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	101	3	1	04	01	H2775_101_3	5	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					2.00		5.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2775	101	3	1	04	01	H2775_101_3	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					7.00		17.50											12.00		30.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	101	3	1	04	01	H2775_101_3	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	101	3	1	04	01	H2775_101_3	5	Non-Preferred Drug	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											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	101	3	1	04	01	H2775_101_3	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 Drug, Specialty Tier												
H2775	102	1	1	04	01	H2775_102_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	102	1	1	04	01	H2775_102_1	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								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	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H2775	102	1	1	04	01	H2775_102_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		25.00					5.00		12.50											10.00		25.00				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												
H2775	102	1	1	04	01	H2775_102_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	102	1	1	04	01	H2775_102_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								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	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	102	1	1	04	01	H2775_102_1	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												
H2775	102	2	1	04	01	H2775_102_2	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	102	2	1	04	01	H2775_102_2	5	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								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	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H2775	102	2	1	04	01	H2775_102_2	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		25.00					5.00		12.50											10.00		25.00				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												
H2775	102	2	1	04	01	H2775_102_2	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	102	2	1	04	01	H2775_102_2	5	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								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	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	102	2	1	04	01	H2775_102_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 Drug, Specialty Tier												
H2775	103	1	1	04	01	H2775_103_1	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					2.00		5.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	103	1	1	04	01	H2775_103_1	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					2.00		5.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2775	103	1	1	04	01	H2775_103_1	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					7.00		17.50											12.00		30.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	103	1	1	04	01	H2775_103_1	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	103	1	1	04	01	H2775_103_1	4	Non-Preferred Drug	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											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	103	1	1	04	01	H2775_103_1	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												
H2775	103	2	1	04	01	H2775_103_2	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					2.00		5.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	103	2	1	04	01	H2775_103_2	6	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					2.00		5.00											7.00		17.50				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2775	103	2	1	04	01	H2775_103_2	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					7.00		17.50											12.00		30.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	103	2	1	04	01	H2775_103_2	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	103	2	1	04	01	H2775_103_2	6	Non-Preferred Drug	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											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	103	2	1	04	01	H2775_103_2	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												
H2793	003	0	1	01	01	H2793_003_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												
H2793	003	0	1	01	01	H2793_003_0	6	Preferred Generic	4	11	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		
H2793	003	0	1	01	01	H2793_003_0	6	Generic	4	11	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												
H2793	003	0	1	01	01	H2793_003_0	6	Generic	4	11	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		
H2793	003	0	1	01	01	H2793_003_0	6	Preferred Brand	4	11	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												
H2793	003	0	1	01	01	H2793_003_0	6	Non-Preferred Drug	4	11	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												
H2793	003	0	1	01	01	H2793_003_0	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												
H2793	004	0	1	01	01	H2793_004_0	7	Preferred Generic	4	11	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												
H2793	004	0	1	01	01	H2793_004_0	7	Preferred Generic	4	11	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		
H2793	004	0	1	01	01	H2793_004_0	7	Generic	4	11	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				4.52	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	7	Generic	4	11	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		
H2793	004	0	1	01	01	H2793_004_0	7	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				80.08	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				39.05	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	7	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												
H2793	005	0	1	01	01	H2793_005_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												
H2793	005	0	1	01	01	H2793_005_0	6	Preferred Generic	4	11	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		
H2793	005	0	1	01	01	H2793_005_0	6	Generic	4	11	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												
H2793	005	0	1	01	01	H2793_005_0	6	Generic	4	11	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		
H2793	005	0	1	01	01	H2793_005_0	6	Preferred Brand	4	11	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												
H2793	005	0	1	01	01	H2793_005_0	6	Non-Preferred Drug	4	11	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												
H2793	005	0	1	01	01	H2793_005_0	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, Select Care Drugs												
H2793	005	0	1	01	01	H2793_005_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												
H2802	001	0	1	01	01	H2802_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				897.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				755.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				773.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				818.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				813.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				1021.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				1229.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				896.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				914.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				1007.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				840.00	30		30																										30						30			30			30								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				2	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				2	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				2	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				2	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				2	2						90	30		31				984.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				814.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				1048.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				829.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1020.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	01	01	H2802_025_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				888.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				824.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				975.00	32		32																										32						32			32			32								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				2	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				2	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				2	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				2	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				2	2						90	30		31				999.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				814.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	01	01	H2802_031_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				748.00	32		32																										32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	01	01	H2802_032_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				898.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	01	01	H2802_033_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				984.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	01	01	H2802_034_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				701.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	035	0	1	01	01	H2802_035_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				807.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				850.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				856.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1063.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1091.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	01	01	H2802_048_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H2802	048	0	1	01	01	H2802_048_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	048	0	1	01	01	H2802_048_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	01	01	H2802_048_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	048	0	1	01	01	H2802_048_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				909.00	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	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								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	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H2816	013	0	1	09	04	H2816_013_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		25.00					5.00		12.50											10.00		25.00				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												
H2816	013	0	1	09	04	H2816_013_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								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	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_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												
H2816	019	0	1	09	04	H2816_019_0	4	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					1.00		2.50											7.00		17.50				1.00		0.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	4	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								7.00		17.50					1.00		2.50											7.00		17.50				1.00		0.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2816	019	0	1	09	04	H2816_019_0	4	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		30.00					7.00		17.50											12.00		30.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	4	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_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		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	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_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												
H2829	001	0	1	01	01	H2829_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2829	001	0	1	01	01	H2829_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2829	001	0	1	01	01	H2829_001_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2829	001	0	1	01	01	H2829_001_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	10.00					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		
H2829	001	0	1	01	01	H2829_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2829	001	0	1	01	01	H2829_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												
H2829	001	0	1	01	01	H2829_001_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												
H2879	001	0	1	01	01	H2879_001_0	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				99.00	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	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				506.45	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2906	005	0	1	04	01	H2906_005_0	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	6	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	6	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	6	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	6	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	6	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				264.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2906	006	0	1	04	01	H2906_006_0	6	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	7	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	7	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	7	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	7	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	7	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				264.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2906	007	0	1	04	01	H2906_007_0	7	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	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, Select Care Drugs												
H2915	003	0	1	01	01	H2915_003_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 Drug, Specialty Tier, Select Care Drugs												
H2915	003	0	1	01	01	H2915_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 Drug, Specialty Tier, Select Care Drugs												
H2915	003	0	1	01	01	H2915_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	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												
H2915	003	0	1	01	01	H2915_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, Select Care Drugs												
H2915	003	0	1	01	01	H2915_003_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 Drug, Specialty Tier, Select Care Drugs												
H2915	005	0	1	01	01	H2915_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, Select Care Drugs												
H2915	005	0	1	01	01	H2915_005_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	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												
H2915	005	0	1	01	01	H2915_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 Drug, Specialty Tier, Select Care Drugs												
H2915	005	0	1	01	01	H2915_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																			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												
H2915	005	0	1	01	01	H2915_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 Drug, Specialty Tier, Select Care Drugs												
H2915	005	0	1	01	01	H2915_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 Drug, Specialty Tier, Select Care Drugs												
H2915	006	0	1	01	01	H2915_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 Drug, Specialty Tier, Select Care Drugs												
H2915	006	0	1	01	01	H2915_006_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	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												
H2915	006	0	1	01	01	H2915_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																			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												
H2915	006	0	1	01	01	H2915_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																			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												
H2915	006	0	1	01	01	H2915_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 Drug, Specialty Tier, Select Care Drugs												
H2915	006	0	1	01	01	H2915_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 Drug, Specialty Tier, Select Care Drugs												
H2944	013	0	1	09	04	H2944_013_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												
H2944	013	0	1	09	04	H2944_013_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_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												
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	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	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	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	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	124	0	1	09	04	H2944_124_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_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												
H2944	127	0	1	09	04	H2944_127_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												
H2944	127	0	1	09	04	H2944_127_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_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												
H2960	004	0	1	01	01	H2960_004_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																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	004	0	1	01	01	H2960_004_0	5	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	5	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	5	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	5	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	5	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	2.00		5.00																					4.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	5	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		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	5	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	5	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	5	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	5	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	5	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	018	0	1	01	01	H2960_018_0	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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	4	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		
H2960	019	0	1	01	01	H2960_019_0	5	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		5.00																					0.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	5	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	2.00		5.00																					0.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	019	0	1	01	01	H2960_019_0	5	Generic	4	01	1	2	2	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												
H2960	019	0	1	01	01	H2960_019_0	5	Generic	4	01	1	2	2	3	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										1		
H2960	019	0	1	01	01	H2960_019_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																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	5	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	019	0	1	01	01	H2960_019_0	5	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	019	0	1	01	01	H2960_019_0	5	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	019	0	1	01	01	H2960_019_0	5	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	12	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	011	0	1	01	01	H2962_011_0	12	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	011	0	1	01	01	H2962_011_0	12	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	011	0	1	01	01	H2962_011_0	12	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	011	0	1	01	01	H2962_011_0	12	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	011	0	1	01	01	H2962_011_0	12	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	011	0	1	01	01	H2962_011_0	12	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	011	0	1	01	01	H2962_011_0	12	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	012	0	1	01	01	H2962_012_0	12	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	012	0	1	01	01	H2962_012_0	12	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	012	0	1	01	01	H2962_012_0	12	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	012	0	1	01	01	H2962_012_0	12	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	012	0	1	01	01	H2962_012_0	12	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	012	0	1	01	01	H2962_012_0	12	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	012	0	1	01	01	H2962_012_0	12	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												
H2986	001	0	1	01	01	H2986_001_0	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	9	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	006	0	1	01	01	H2986_006_0	8	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	006	0	1	01	01	H2986_006_0	8	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	006	0	1	01	01	H2986_006_0	8	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	006	0	1	01	01	H2986_006_0	8	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	006	0	1	01	01	H2986_006_0	8	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	006	0	1	01	01	H2986_006_0	8	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	006	0	1	01	01	H2986_006_0	8	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	006	0	1	01	01	H2986_006_0	8	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	007	0	1	01	01	H2986_007_0	9	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	007	0	1	01	01	H2986_007_0	9	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	007	0	1	01	01	H2986_007_0	9	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	007	0	1	01	01	H2986_007_0	9	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	007	0	1	01	01	H2986_007_0	9	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	007	0	1	01	01	H2986_007_0	9	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	007	0	1	01	01	H2986_007_0	9	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	007	0	1	01	01	H2986_007_0	9	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	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 Drugs, Non-Medicare OTC Drugs	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	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 Drugs, Non-Medicare OTC Drugs	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	4	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	4	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	5	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																					27.00																9.00				9.00		0.30						0.29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	001	0	1	01	01	H3054_001_0	5	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																					141.00																47.00				47.00		1.57						1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	001	0	1	01	01	H3054_001_0	5	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																					300.00																100.00				100.00		3.33						3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	001	0	1	01	01	H3054_001_0	5	Specialty Tier	2	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				792.99	25	25	25																				25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	003	0	1	01	01	H3054_003_0	5	Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	7.50	15.00	22.50																					22.50																7.50				7.50		0.25						0.24	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	003	0	1	01	01	H3054_003_0	5	Preferred Brand	2	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	003	0	1	01	01	H3054_003_0	5	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																					300.00																100.00				100.00		3.33						3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	003	0	1	01	01	H3054_003_0	5	Specialty Tier	2	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				959.43	25	25	25																				25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	004	0	1	01	01	H3054_004_0	5	Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	6.50	13.00	19.50																					19.50																6.50				6.50		0.22						0.21	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	004	0	1	01	01	H3054_004_0	5	Preferred Brand	2	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	004	0	1	01	01	H3054_004_0	5	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																					300.00																100.00				100.00		3.33						3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	004	0	1	01	01	H3054_004_0	5	Specialty Tier	2	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				969.31	25	25	25																				25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3071	002	0	1	01	01	H3071_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	1.00	0.00	0.00																									3.00	6.00	9.00				1.00	0.00	0.00				1.00				1.00		0.03				0.10	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	6	Generic	4	11	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	5.00	5.00	5.00																									15.00	30.00	45.00				5.00	5.00	5.00				5.00				5.00		0.17				0.50	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	6	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	70.00																									105.00	210.00	315.00				35.00	70.00	70.00				35.00				35.00		1.17				3.50	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_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				100.00	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	6	Specialty Tier	4	11	1	1	5	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				737.29	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				774.00	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				16.22	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				97.42	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				41.54	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				561.61	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								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												
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								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		
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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	5	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_0	5	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								13.00	26.00	39.00					2.00	4.00	0.00											13.00	26.00	39.00				2.00	4.00	0.00					13.00			13.00			0.43	0.00		0.43	0.00	0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	048	0	1	01	01	H3152_048_0	5	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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_0	5	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	10.00					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		
H3152	048	0	1	01	01	H3152_048_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_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												
H3152	048	0	1	01	01	H3152_048_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												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	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		
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								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 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								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			0.50	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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												
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								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		
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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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												
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								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		
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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	088	0	1	01	01	H3152_088_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	088	0	1	01	01	H3152_088_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	088	0	1	01	01	H3152_088_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	088	0	1	01	01	H3152_088_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	10.00					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		
H3152	088	0	1	01	01	H3152_088_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	088	0	1	01	01	H3152_088_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	088	0	1	01	01	H3152_088_0	3	Specialty Tier	4	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												
H3154	004	0	1	01	01	H3154_004_0	5	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	5	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	5	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					28.00	56.00	84.00					28.00	56.00	84.00																35.00				35.00			1.17	0.93	0.93			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	5	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	5	Specialty Tier	2	11	1	1	5	1		010	01			1				30											30		31											980.18	25						980.18	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								35.00	70.00	105.00					28.00	56.00	84.00					28.00	56.00	84.00																35.00				35.00			1.17	0.93	0.93			1.13	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											1232.32	25						1232.32	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	029	0	1	01	01	H3154_029_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 Drug, Specialty Tier												
H3154	029	0	1	01	01	H3154_029_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					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 Drug, Specialty Tier												
H3154	029	0	1	01	01	H3154_029_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					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 Drug, Specialty Tier												
H3154	029	0	1	01	01	H3154_029_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											90.65	40	40	40				79.32	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	029	0	1	01	01	H3154_029_0	4	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1237.79	28						1237.79	28																							28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_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 Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_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 Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_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 Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_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											90.65	40	40	40				79.32	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_0	6	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1237.79	28						1237.79	28																							28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, 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 Drug, 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 Drug, 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 Drug, Specialty Tier												
H3154	031	0	1	01	01	H3154_031_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											90.65	40	40	40				79.32	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, 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											1281.99	29						1281.99	29																							29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_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								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 Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_032_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					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 Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_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					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 Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_032_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											90.65	40	40	40				79.32	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_032_0	4	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1458.82	33						1458.82	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	033	0	1	02	01	H3154_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								8.00	16.00	24.00					1.00	2.00	3.00					.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	033	0	1	02	01	H3154_033_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 Drug, Specialty Tier												
H3154	033	0	1	02	01	H3154_033_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 Drug, Specialty Tier												
H3154	033	0	1	02	01	H3154_033_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											90.65	40	40	40				79.32	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	033	0	1	02	01	H3154_033_0	6	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1458.82	33						1458.82	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	001	0	1	01	01	H3170_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								14.00	28.00	42.00					4.00	8.00	12.00					4.00	8.00	0.00																14.00				4.00			0.47	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	001	0	1	01	01	H3170_001_0	7	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 Drug, Specialty Tier												
H3170	001	0	1	01	01	H3170_001_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					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 Drug, Specialty Tier												
H3170	001	0	1	01	01	H3170_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											52.00	45	45	45				50.00	45	45	45				45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	001	0	1	01	01	H3170_001_0	7	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												
H3170	002	0	1	02	01	H3170_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								12.00	24.00	36.00					2.00	4.00	6.00					2.00	4.00	0.00																12.00				2.00			0.40	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	002	0	1	02	01	H3170_002_0	7	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 Drug, Specialty Tier												
H3170	002	0	1	02	01	H3170_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								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 Drug, Specialty Tier												
H3170	002	0	1	02	01	H3170_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											55.00	45	45	45				55.00	45	45	45				45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	002	0	1	02	01	H3170_002_0	7	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												
H3204	001	0	1	01	01	H3204_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	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	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	001	0	1	01	01	H3204_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	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	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	001	0	1	01	01	H3204_001_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												
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					33																										33						33					33			33								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												
H3219	001	0	1	04	01	H3219_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	001	0	1	04	01	H3219_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	001	0	1	04	01	H3219_001_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	001	0	1	04	01	H3219_001_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	10.00					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		
H3219	001	0	1	04	01	H3219_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	001	0	1	04	01	H3219_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												
H3219	001	0	1	04	01	H3219_001_0	4	Specialty Tier	4	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												
H3219	002	0	1	04	01	H3219_002_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	002	0	1	04	01	H3219_002_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	002	0	1	04	01	H3219_002_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	002	0	1	04	01	H3219_002_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	10.00					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		
H3219	002	0	1	04	01	H3219_002_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	002	0	1	04	01	H3219_002_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												
H3219	002	0	1	04	01	H3219_002_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												
H3219	003	0	1	04	01	H3219_003_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	003	0	1	04	01	H3219_003_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	003	0	1	04	01	H3219_003_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	003	0	1	04	01	H3219_003_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	10.00					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		
H3219	003	0	1	04	01	H3219_003_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	003	0	1	04	01	H3219_003_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												
H3219	003	0	1	04	01	H3219_003_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												
H3219	004	0	1	04	01	H3219_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	004	0	1	04	01	H3219_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	004	0	1	04	01	H3219_004_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	004	0	1	04	01	H3219_004_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	10.00					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		
H3219	004	0	1	04	01	H3219_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3219	004	0	1	04	01	H3219_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												
H3219	004	0	1	04	01	H3219_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												
H3237	001	0	1	48	05	H3237_001_0	1	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	3.40	0.00	3.40	0.00	3.40	0.00	3.40			
H3237	001	0	1	48	05	H3237_001_0	1	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	8.50	0.00	8.50	0.00	8.50	0.00	8.50			
H3237	001	0	1	48	05	H3237_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																																														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	1	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	3.40	0.00	3.40	0.00	3.40	0.00	3.40			
H3237	002	0	1	48	05	H3237_002_0	1	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	8.50	0.00	8.50	0.00	8.50	0.00	8.50			
H3237	002	0	1	48	05	H3237_002_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																																														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			
H3239	001	0	1	01	01	H3239_001_0	3	Preferred Generic	3	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	0.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	001	0	1	01	01	H3239_001_0	3	Generic	3	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	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 Drug, Specialty Tier												
H3239	001	0	1	01	01	H3239_001_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																			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												
H3239	001	0	1	01	01	H3239_001_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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3239	001	0	1	01	01	H3239_001_0	3	Specialty Tier	3	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												
H3240	013	0	1	01	01	H3240_013_0	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								16.00	32.00	48.00					16.00	32.00	48.00					16.00		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												
H3240	013	0	1	01	01	H3240_013_0	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								42.00	84.00	126.00					42.00	84.00	126.00					42.00		126.00																42.00				42.00			1.40	1.40	1.40			1.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								97.00	194.00	291.00					92.00	184.00	276.00					92.00		276.00																97.00				97.00			3.23	3.07	3.07			2.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_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												
H3240	013	0	1	01	01	H3240_013_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								12.00	24.00	36.00					12.00	24.00	36.00					12.00		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	016	0	1	01	01	H3240_016_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00		135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	016	0	1	01	01	H3240_016_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								98.00	196.00	294.00					93.00	186.00	279.00					93.00		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												
H3240	016	0	1	01	01	H3240_016_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	016	0	1	01	01	H3240_016_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		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												
H3240	017	0	1	02	01	H3240_017_0	8	Generic	3	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	Preferred Brand	3	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	110		1				30	60	90	1	2	30		90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00		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												30							30						30																	30			30								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	110		1				30	60	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	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	8	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	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	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00		42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H3240	021	0	1	01	01	H3240_021_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3240	022	0	1	01	01	H3240_022_0	6	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		8.00																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												
H3240	022	0	1	01	01	H3240_022_0	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		20.00																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	022	0	1	01	01	H3240_022_0	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	022	0	1	01	01	H3240_022_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	022	0	1	01	01	H3240_022_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												
H3240	022	0	1	01	01	H3240_022_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	022	0	1	01	01	H3240_022_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	9	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	9	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	9	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	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													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	9	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	9	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3293	001	0	1	01	01	H3293_001_0	4	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	001	0	1	01	01	H3293_001_0	4	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		1
H3293	001	0	1	01	01	H3293_001_0	4	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	001	0	1	01	01	H3293_001_0	4	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3293	001	0	1	01	01	H3293_001_0	4	Preferred Brand	4	10	1	2	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	001	0	1	01	01	H3293_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	5.00		15.00																					15.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	001	0	1	01	01	H3293_001_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				973.47	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	002	0	1	01	01	H3293_002_0	4	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	002	0	1	01	01	H3293_002_0	4	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		1
H3293	002	0	1	01	01	H3293_002_0	4	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	002	0	1	01	01	H3293_002_0	4	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3293	002	0	1	01	01	H3293_002_0	4	Preferred Brand	4	10	1	2	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	002	0	1	01	01	H3293_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	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												
H3293	002	0	1	01	01	H3293_002_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				955.68	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	003	0	1	01	01	H3293_003_0	4	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	003	0	1	01	01	H3293_003_0	4	Generic	4	01	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	003	0	1	01	01	H3293_003_0	4	Preferred Brand	4	10	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	003	0	1	01	01	H3293_003_0	4	Non-Preferred Drug	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	003	0	1	01	01	H3293_003_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1092.76	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	004	0	1	01	01	H3293_004_0	4	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	004	0	1	01	01	H3293_004_0	4	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		1
H3293	004	0	1	01	01	H3293_004_0	4	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	004	0	1	01	01	H3293_004_0	4	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3293	004	0	1	01	01	H3293_004_0	4	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	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												
H3293	004	0	1	01	01	H3293_004_0	4	Non-Preferred Drug	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	004	0	1	01	01	H3293_004_0	4	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				573.36	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_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												
H3305	015	0	1	02	01	H3305_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3305	015	0	1	02	01	H3305_015_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		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	7	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		80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				79.34	27		27																		27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				800.75	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_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												
H3305	021	0	1	02	01	H3305_021_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3305	021	0	1	02	01	H3305_021_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		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_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		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				80.47	27		27																		27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				961.13	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	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	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		30.00																15.00				15.00		0.50			0.50			0.48	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		90.00																45.00				45.00		1.50			1.50			1.45	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				78.04	27		27																		27		27															27			27								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				802.74	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	0.00		0.00																			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	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		24.00																12.00				12.00		0.40			0.40			0.39	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		94.00																47.00				47.00		1.57			1.57			1.52	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				87.12	27		27																		27		27															27			27								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				621.87	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				749.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				899.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				356.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				877.00	27		27																										27						27			27			27								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				2	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				2	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				2	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				2	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				2	2						90	30		31				856.00	25		25																										25						25			25			25								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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	28						1.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	063	0	1	01	01	H3312_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	063	0	1	01	01	H3312_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	063	0	1	01	01	H3312_063_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	063	0	1	01	01	H3312_063_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	10.00					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		
H3312	063	0	1	01	01	H3312_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	063	0	1	01	01	H3312_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												
H3312	063	0	1	01	01	H3312_063_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	064	0	1	01	01	H3312_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	064	0	1	01	01	H3312_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	064	0	1	01	01	H3312_064_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	064	0	1	01	01	H3312_064_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	10.00					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		
H3312	064	0	1	01	01	H3312_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	064	0	1	01	01	H3312_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												
H3312	064	0	1	01	01	H3312_064_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	065	0	1	01	01	H3312_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	065	0	1	01	01	H3312_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	065	0	1	01	01	H3312_065_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	065	0	1	01	01	H3312_065_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	10.00					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		
H3312	065	0	1	01	01	H3312_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	065	0	1	01	01	H3312_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												
H3312	065	0	1	01	01	H3312_065_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												
H3328	002	0	1	01	01	H3328_002_0	9	Preferred Generic	3	11	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	9	Generic	3	11	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	9	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	9	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	002	0	1	01	01	H3328_002_0	9	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		34				818.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	8	Preferred Generic	2	11	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	8	Generic	2	11	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	8	Preferred Brand	2	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		34				81.00	22		22																				18															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	8	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				85.00	33		33																				29															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	8	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		34				920.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	8	Preferred Generic	2	11	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	016	0	1	01	01	H3328_016_0	8	Generic	2	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	14.50		43.50																					29.00																14.50				14.50		0.48						0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	8	Preferred Brand	2	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		34				77.00	23		23																				19															23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	8	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				62.00	25		25																				21															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	8	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		34				836.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	7	Preferred Generic	3	11	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	7	Generic	3	11	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	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	017	0	1	01	01	H3328_017_0	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	017	0	1	01	01	H3328_017_0	7	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		34				774.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	021	0	1	01	01	H3328_021_0	6	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	5.00		15.00																					10.00																5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	021	0	1	01	01	H3328_021_0	6	Generic	4	11	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	021	0	1	01	01	H3328_021_0	6	Preferred Brand	4	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	021	0	1	01	01	H3328_021_0	6	Non-Preferred Drug	4	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	021	0	1	01	01	H3328_021_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34				1732.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	10	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					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												
H3330	021	1	1	01	01	H3330_021_1	10	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												
H3330	021	1	1	01	01	H3330_021_1	10	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					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 Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	10	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												
H3330	021	1	1	01	01	H3330_021_1	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											371.69	29						371.69	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	10	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					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												
H3330	021	2	1	01	01	H3330_021_2	10	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												
H3330	021	2	1	01	01	H3330_021_2	10	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					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 Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	10	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												
H3330	021	2	1	01	01	H3330_021_2	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											371.69	29						371.69	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	9	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					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												
H3330	021	3	1	01	01	H3330_021_3	9	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												
H3330	021	3	1	01	01	H3330_021_3	9	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					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 Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	9	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												
H3330	021	3	1	01	01	H3330_021_3	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											371.69	29						371.69	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	9	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					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												
H3330	021	4	1	01	01	H3330_021_4	9	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												
H3330	021	4	1	01	01	H3330_021_4	9	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					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 Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	9	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												
H3330	021	4	1	01	01	H3330_021_4	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											371.69	29						371.69	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	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					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	9	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					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	9	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	9	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												
H3330	032	1	1	01	01	H3330_032_1	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											435.77	28						435.77	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_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					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	11	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					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	11	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	11	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												
H3330	032	2	1	01	01	H3330_032_2	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											435.77	28						435.77	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	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					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	10	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					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	10	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	10	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												
H3330	032	3	1	01	01	H3330_032_3	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											435.77	28						435.77	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	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					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	10	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					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	10	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	10	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												
H3330	032	4	1	01	01	H3330_032_4	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											435.77	28						435.77	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_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					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	9	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					18.00	36.00	54.00					18.00	36.00	54.00																20.00				20.00			0.67	0.60	0.60			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	9	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					45.00	90.00	135.00					45.00	90.00	135.00																47.00				47.00			1.57	1.50	1.50			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_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								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												
H3330	036	0	1	01	01	H3330_036_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											267.45	28						267.45	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	038	0	1	01	01	H3330_038_0	11	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					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												
H3330	038	0	1	01	01	H3330_038_0	11	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												
H3330	038	0	1	01	01	H3330_038_0	11	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					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 Drug, Specialty Tier												
H3330	038	0	1	01	01	H3330_038_0	11	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												
H3330	038	0	1	01	01	H3330_038_0	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											313.40	29						313.40	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	1	1	01	01	H3330_039_1	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					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	1	1	01	01	H3330_039_1	9	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					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	1	1	01	01	H3330_039_1	9	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	1	1	01	01	H3330_039_1	9	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												
H3330	039	1	1	01	01	H3330_039_1	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											374.64	25						374.64	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	2	1	01	01	H3330_039_2	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					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	2	1	01	01	H3330_039_2	9	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					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	2	1	01	01	H3330_039_2	9	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	2	1	01	01	H3330_039_2	9	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												
H3330	039	2	1	01	01	H3330_039_2	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											374.64	25						374.64	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	040	0	1	01	01	H3330_040_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					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	040	0	1	01	01	H3330_040_0	10	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					18.00	36.00	54.00					18.00	36.00	54.00																20.00				20.00			0.67	0.60	0.60			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	040	0	1	01	01	H3330_040_0	10	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					45.00	90.00	135.00					45.00	90.00	135.00																47.00				47.00			1.57	1.50	1.50			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	040	0	1	01	01	H3330_040_0	10	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												
H3330	040	0	1	01	01	H3330_040_0	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											429.08	25						429.08	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	1	1	02	01	H3330_041_1	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					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	1	1	02	01	H3330_041_1	9	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					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	1	1	02	01	H3330_041_1	9	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	1	1	02	01	H3330_041_1	9	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												
H3330	041	1	1	02	01	H3330_041_1	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											411.17	28						411.17	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	2	1	02	01	H3330_041_2	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					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	2	1	02	01	H3330_041_2	9	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					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	2	1	02	01	H3330_041_2	9	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	2	1	02	01	H3330_041_2	9	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												
H3330	041	2	1	02	01	H3330_041_2	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											411.17	28						411.17	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	4	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 Drug, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	4	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3335	005	0	1	04	01	H3335_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		200.00																					200.00																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	4	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	4	Generic	4	01	1	2	2	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 Drug, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	4	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3335	006	0	1	04	01	H3335_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		200.00																					200.00																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	4	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	4	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 Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	4	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_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		200.00																					200.00																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	4	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	4	Generic	4	01	1	2	2	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 Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	4	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_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		200.00																					200.00																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	4	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	4	Preferred Generic	3	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 Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	4	Generic	3	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 Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	4	Preferred Brand	3	11	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 Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	4	Non-Preferred Drug	3	11	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 Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	4	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	4	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 Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	4	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																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	4	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	4	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 Drug, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	4	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																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	4	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	4	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 Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	4	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																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	4	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	31		31																				31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	054	0	1	04	01	H3335_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	4	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 Drug, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	4	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																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	4	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	31		31																				31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3342	019	0	1	04	01	H3342_019_0	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		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	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								43.00	86.00	129.00					38.00	76.00	114.00					38.00		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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								93.00	186.00	279.00					88.00	176.00	264.00					88.00		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	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												
H3342	019	0	1	04	01	H3342_019_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	Preferred Brand	4	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		34	100.00		250.00																					250.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				1574.00	32																																					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_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												
H3351	002	0	1	02	01	H3351_002_0	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		10.00																					10.00																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	6	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																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	6	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	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												
H3351	006	0	1	02	01	H3351_006_0	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		24.00																					24.00																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	7	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																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	7	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	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												
H3351	010	0	1	01	01	H3351_010_0	6	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 Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	6	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																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	6	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	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												
H3351	011	0	1	01	01	H3351_011_0	7	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 Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	7	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																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	7	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	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												
H3351	012	0	1	02	01	H3351_012_0	7	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 Drug, Specialty Tier												
H3351	012	0	1	02	01	H3351_012_0	7	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3351	012	0	1	02	01	H3351_012_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																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	7	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	02	01	H3351_013_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												
H3351	013	0	1	02	01	H3351_013_0	7	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 Drug, Specialty Tier												
H3351	013	0	1	02	01	H3351_013_0	7	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3351	013	0	1	02	01	H3351_013_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	02	01	H3351_013_0	7	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	6	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 Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	6	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 Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_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																					90.00																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	6	Non-Preferred Drug	4	11	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 Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	6	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	01	01	H3351_016_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												
H3351	016	0	1	01	01	H3351_016_0	7	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 Drug, Specialty Tier												
H3351	016	0	1	01	01	H3351_016_0	7	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3351	016	0	1	01	01	H3351_016_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	01	01	H3351_016_0	7	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	26		26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_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												
H3351	017	0	1	01	01	H3351_017_0	6	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		28.00																					28.00																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	6	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																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	6	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	26		26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	018	0	1	02	01	H3351_018_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												
H3351	018	0	1	02	01	H3351_018_0	7	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 Drug, Specialty Tier												
H3351	018	0	1	02	01	H3351_018_0	7	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3351	018	0	1	02	01	H3351_018_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	018	0	1	02	01	H3351_018_0	7	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	27		27																				27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	019	0	1	02	01	H3351_019_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												
H3351	019	0	1	02	01	H3351_019_0	7	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		28.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	019	0	1	02	01	H3351_019_0	7	Preferred Brand	4	11	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 Drug, Specialty Tier												
H3351	019	0	1	02	01	H3351_019_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		200.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	019	0	1	02	01	H3351_019_0	7	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	30		30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_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 Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_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																			10.00	20.00	10.00																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	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	47.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_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																			100.00	200.00	100.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_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					26	26	26																		26	26	26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	8	Preferred Brand	4	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		34	100.00		250.00																					250.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				1275.00	32																																					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	6	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		34				59.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				55.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				784.00	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	8	Preferred Brand	4	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		34	100.00		250.00																					250.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				1270.00	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	035	0	1	01	01	H3362_035_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3362	035	0	1	01	01	H3362_035_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3362	035	0	1	01	01	H3362_035_0	7	Preferred Brand	4	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3362	035	0	1	01	01	H3362_035_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		34	100.00		250.00																					250.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3362	035	0	1	01	01	H3362_035_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				1073.00	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3362	035	0	1	01	01	H3362_035_0	7	Select Care Drugs	4	11	1	2	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3379	001	0	1	01	01	H3379_001_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				722.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				804.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	040	0	1	01	01	H3379_040_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				850.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	01	01	H3379_041_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				850.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_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					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	6	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	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					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	6	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	6	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											97.64	50		50				97.28	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	6	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	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					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	6	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	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					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	6	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	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					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	6	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	5	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	5	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	5	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	5	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	5	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	6	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	059	0	1	02	01	H3384_059_0	6	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		
H3384	059	0	1	02	01	H3384_059_0	6	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												
H3384	059	0	1	02	01	H3384_059_0	6	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	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					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	6	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	062	0	1	01	01	H3384_062_0	6	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	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					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	6	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	6	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	6	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	02	01	H3384_063_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					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	063	0	1	02	01	H3384_063_0	5	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	063	0	1	02	01	H3384_063_0	5	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	063	0	1	02	01	H3384_063_0	5	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	02	01	H3384_063_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											98.57	48		48				98.18	48		48				48		48															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	063	0	1	02	01	H3384_063_0	5	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												25		25					25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	064	0	1	02	01	H3384_064_0	5	Preferred Generic	4	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					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												
H3384	064	0	1	02	01	H3384_064_0	5	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								5.00		15.00					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		
H3384	064	0	1	02	01	H3384_064_0	5	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		30.00					5.00		15.00					5.00		12.50																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	064	0	1	02	01	H3384_064_0	5	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	064	0	1	02	01	H3384_064_0	5	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	064	0	1	02	01	H3384_064_0	5	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												31		31					31		31				31		31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	14	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	14	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	14	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	14	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	14	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1588.16	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	13	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	13	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	13	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	13	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	13	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1662.83	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	12	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	12	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	12	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	12	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	12	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1919.14	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				1399.46	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3404	003	1	1	04	01	H3404_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								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 Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_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					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 Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_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					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												
H3404	003	1	1	04	01	H3404_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											55.86	50	50	50				55.86	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1099.95	33						1099.95	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	3	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 Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	3	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 Drug, Specialty Tier, Select Care Drugs										1		
H3404	003	2	1	04	01	H3404_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								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 Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_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					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 Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_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					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												
H3404	003	2	1	04	01	H3404_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											55.86	50	50	50				55.86	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1099.95	33						1099.95	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	3	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 Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	3	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 Drug, 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					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	5	1	04	01	H3416_001_5	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												
H3416	001	5	1	04	01	H3416_001_5	6	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	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		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	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																									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	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												
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	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												
H3416	002	3	1	04	01	H3416_002_3	6	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	6	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	6	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	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		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	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																									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	6	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	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							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	4	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	4	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	4	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	4	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	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					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	4	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	4	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	4	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	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							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	4	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	4	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	4	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	4	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	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					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	4	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	4	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	4	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	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							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	4	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	4	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	4	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	4	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	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					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	4	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	4	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	4	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	4	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	4	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	4	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	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					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	4	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	4	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	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								2.00	4.00	6.00					2.00	4.00	6.00					2.00		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	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								16.00	32.00	48.00					16.00	32.00	48.00					16.00		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	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	11	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	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	12	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								2.00	4.00	6.00					2.00	4.00	6.00					2.00		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	12	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								18.00	36.00	54.00					18.00	36.00	54.00					18.00		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	12	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	12	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	12	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	12	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	12	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	7	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	7	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	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	014	0	1	01	01	H3447_014_0	6	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	110		1				30	60	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	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	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	017	0	1	02	01	H3447_017_0	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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												
H3447	017	0	1	02	01	H3447_017_0	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	017	0	1	02	01	H3447_017_0	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	017	0	1	02	01	H3447_017_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00		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												
H3447	017	0	1	02	01	H3447_017_0	10	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	017	0	1	02	01	H3447_017_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								3.00	6.00	9.00					3.00	6.00	9.00					3.00		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												
H3447	018	0	1	01	01	H3447_018_0	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	018	0	1	01	01	H3447_018_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	018	0	1	01	01	H3447_018_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												
H3447	018	0	1	01	01	H3447_018_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	10	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	019	0	1	01	01	H3447_019_0	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								5.00	10.00	15.00					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												
H3447	019	0	1	01	01	H3447_019_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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												
H3447	019	0	1	01	01	H3447_019_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	019	0	1	01	01	H3447_019_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	019	0	1	01	01	H3447_019_0	11	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												
H3447	019	0	1	01	01	H3447_019_0	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	019	0	1	01	01	H3447_019_0	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	020	0	1	01	01	H3447_020_0	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								5.00	10.00	15.00					5.00	10.00	15.00					5.00		15.00																5.00				5.00			0.17	0.17	0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	020	0	1	01	01	H3447_020_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	020	0	1	01	01	H3447_020_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												
H3447	020	0	1	01	01	H3447_020_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	10	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	021	0	1	01	01	H3447_021_0	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00		0.00																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												
H3447	021	0	1	01	01	H3447_021_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00		18.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	021	0	1	01	01	H3447_021_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	021	0	1	01	01	H3447_021_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	021	0	1	01	01	H3447_021_0	11	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												
H3447	021	0	1	01	01	H3447_021_0	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	021	0	1	01	01	H3447_021_0	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	022	0	1	01	01	H3447_022_0	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00		0.00																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												
H3447	022	0	1	01	01	H3447_022_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00		18.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	022	0	1	01	01	H3447_022_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	022	0	1	01	01	H3447_022_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	022	0	1	01	01	H3447_022_0	11	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												
H3447	022	0	1	01	01	H3447_022_0	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	022	0	1	01	01	H3447_022_0	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	023	0	1	01	01	H3447_023_0	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00		0.00																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												
H3447	023	0	1	01	01	H3447_023_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00		18.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	023	0	1	01	01	H3447_023_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	023	0	1	01	01	H3447_023_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	023	0	1	01	01	H3447_023_0	11	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												
H3447	023	0	1	01	01	H3447_023_0	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	023	0	1	01	01	H3447_023_0	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	024	0	1	01	01	H3447_024_0	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								12.00	24.00	36.00					12.00	24.00	36.00					12.00		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												
H3447	024	0	1	01	01	H3447_024_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	024	0	1	01	01	H3447_024_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	024	0	1	01	01	H3447_024_0	11	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	024	0	1	01	01	H3447_024_0	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	023	1	1	01	01	H3449_023_1	3	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 Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_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					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, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_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					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												
H3449	023	1	1	01	01	H3449_023_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											73.72	50	50	50				73.72	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											661.57	25						661.57	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_1	3	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 Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_1	3	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 Drug, Specialty Tier, Select Care Drugs										1		
H3449	023	2	1	01	01	H3449_023_2	3	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 Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_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					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, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_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					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												
H3449	023	2	1	01	01	H3449_023_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											73.72	50	50	50				73.72	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											661.57	25						661.57	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_2	3	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 Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_2	3	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 Drug, Specialty Tier, Select Care Drugs										1		
H3449	023	4	1	01	01	H3449_023_4	3	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 Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	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					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, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	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	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												
H3449	023	4	1	01	01	H3449_023_4	3	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.72	50	50	50				73.72	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											661.57	25						661.57	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	3	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 Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	3	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 Drug, Specialty Tier, Select Care Drugs										1		
H3449	024	1	1	01	01	H3449_024_1	3	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 Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_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					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 Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_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					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												
H3449	024	1	1	01	01	H3449_024_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											53.12	50	50	50				53.12	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_1	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1071.68	33						1071.68	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_1	3	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 Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_1	3	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 Drug, Specialty Tier, Select Care Drugs										1		
H3449	024	2	1	01	01	H3449_024_2	3	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 Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_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					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 Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_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					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												
H3449	024	2	1	01	01	H3449_024_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											53.12	50	50	50				53.12	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_2	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1071.68	33						1071.68	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_2	3	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 Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_2	3	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 Drug, Specialty Tier, Select Care Drugs										1		
H3464	001	0	1	01	01	H3464_001_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				894.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				993.00	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				2	2						90	30		31	3.00		6.00																											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				2	2						90	30		31	10.00		20.00																											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				2	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				2	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				2	2						90	30		31				894.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				993.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				894.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				993.00	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	9	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	9	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	9	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	9	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											74.82	50	50	50				75.49	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	9	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	9	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	9	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	9	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	9	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											65.19	50	50	50				65.67	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	9	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	9	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	9	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	9	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	9	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	50	50	50				69.65	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	9	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	9	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	9	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	9	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	9	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											66.33	50	50	50				66.76	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	9	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	010	0	1	01	01	H3471_010_0	9	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	9	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	9	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	9	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											79.72	50	50	50				80.06	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	9	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	013	0	1	02	01	H3471_013_0	9	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	9	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	9	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	9	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											76.95	50	50	50				77.24	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	9	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	9	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	9	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	9	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	9	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											66.90	50	50	50				67.37	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	9	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												
H3471	017	0	1	01	01	H3471_017_0	9	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	017	0	1	01	01	H3471_017_0	9	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	017	0	1	01	01	H3471_017_0	9	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	017	0	1	01	01	H3471_017_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											77.02	50	50	50				77.34	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	017	0	1	01	01	H3471_017_0	9	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												
H3499	001	0	1	01	01	H3499_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								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 Drug, Specialty Tier, Select Care Drugs												
H3499	001	0	1	01	01	H3499_001_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					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, Select Care Drugs												
H3499	001	0	1	01	01	H3499_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					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 Drug, Specialty Tier, Select Care Drugs												
H3499	001	0	1	01	01	H3499_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					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 Drug, Specialty Tier, Select Care Drugs												
H3499	001	0	1	01	01	H3499_001_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 Drug, Specialty Tier, Select Care Drugs												
H3499	001	0	1	01	01	H3499_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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_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	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 Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_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	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, Select Care Drugs												
H3499	002	0	1	01	01	H3499_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					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 Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_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					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 Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_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, Select Care Drugs												
H3499	002	0	1	01	01	H3499_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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	003	0	1	01	01	H3499_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								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 Drug, Specialty Tier, Select Care Drugs												
H3499	003	0	1	01	01	H3499_003_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					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, Select Care Drugs												
H3499	003	0	1	01	01	H3499_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					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 Drug, Specialty Tier, Select Care Drugs												
H3499	003	0	1	01	01	H3499_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					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 Drug, Specialty Tier, Select Care Drugs												
H3499	003	0	1	01	01	H3499_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, Select Care Drugs												
H3499	003	0	1	01	01	H3499_003_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 Drug, Specialty Tier, Select Care Drugs												
H3499	004	0	1	01	01	H3499_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								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 Drug, Specialty Tier, Select Care Drugs												
H3499	004	0	1	01	01	H3499_004_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					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, Select Care Drugs												
H3499	004	0	1	01	01	H3499_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 Drug, Specialty Tier, Select Care Drugs												
H3499	004	0	1	01	01	H3499_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					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 Drug, Specialty Tier, Select Care Drugs												
H3499	004	0	1	01	01	H3499_004_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, Select Care Drugs												
H3499	004	0	1	01	01	H3499_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 Drug, Specialty Tier, Select Care Drugs												
H3499	005	0	1	01	01	H3499_005_0	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												
H3499	005	0	1	01	01	H3499_005_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																			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												
H3499	005	0	1	01	01	H3499_005_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																			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												
H3499	005	0	1	01	01	H3499_005_0	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												
H3499	005	0	1	01	01	H3499_005_0	5	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												
H3499	005	0	1	01	01	H3499_005_0	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												
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	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	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	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	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	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												
H3528	006	0	1	02	01	H3528_006_0	10	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					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										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	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												
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	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												
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											690.00	27						690.00	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	11	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					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	11	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												
H3528	010	0	1	01	01	H3528_010_0	11	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	11	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												
H3528	010	0	1	01	01	H3528_010_0	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											691.52	33						691.52	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	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	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	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												
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	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												
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	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												
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											677.19	27						677.19	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	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	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	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												
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	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												
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	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												
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											677.19	27						677.19	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	012	1	1	02	01	H3528_012_1	10	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					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	012	1	1	02	01	H3528_012_1	10	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												
H3528	012	1	1	02	01	H3528_012_1	10	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	012	1	1	02	01	H3528_012_1	10	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												
H3528	012	1	1	02	01	H3528_012_1	10	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											594.39	27						594.39	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	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	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	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												
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	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												
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	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												
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											594.39	27						594.39	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	013	1	1	01	01	H3528_013_1	11	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					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	013	1	1	01	01	H3528_013_1	11	Preferred Generic	4	01	1	2	1	3		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					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3528	013	1	1	01	01	H3528_013_1	11	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												
H3528	013	1	1	01	01	H3528_013_1	11	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					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										1		
H3528	013	1	1	01	01	H3528_013_1	11	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	013	1	1	01	01	H3528_013_1	11	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												
H3528	013	1	1	01	01	H3528_013_1	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											648.52	27						648.52	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	013	2	1	01	01	H3528_013_2	11	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					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	013	2	1	01	01	H3528_013_2	11	Preferred Generic	4	01	1	2	1	3		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					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3528	013	2	1	01	01	H3528_013_2	11	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												
H3528	013	2	1	01	01	H3528_013_2	11	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					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										1		
H3528	013	2	1	01	01	H3528_013_2	11	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	013	2	1	01	01	H3528_013_2	11	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												
H3528	013	2	1	01	01	H3528_013_2	11	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											648.52	27						648.52	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	014	0	1	01	01	H3528_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								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	014	0	1	01	01	H3528_014_0	11	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												
H3528	014	0	1	01	01	H3528_014_0	11	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	014	0	1	01	01	H3528_014_0	11	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												
H3528	014	0	1	01	01	H3528_014_0	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												
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					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	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					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	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	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	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	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	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	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												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	004	0	1	01	01	H3533_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	004	0	1	01	01	H3533_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	004	0	1	01	01	H3533_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	004	0	1	01	01	H3533_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												
H3533	006	0	1	01	01	H3533_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					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	006	0	1	01	01	H3533_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_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	010	0	1	01	01	H3533_010_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												
H3533	010	0	1	01	01	H3533_010_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_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												
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	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	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	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	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												
H3533	020	0	1	01	01	H3533_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	020	0	1	01	01	H3533_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	020	0	1	01	01	H3533_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	020	0	1	01	01	H3533_020_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												
H3533	021	0	1	01	01	H3533_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					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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	021	0	1	01	01	H3533_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	021	0	1	01	01	H3533_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	021	0	1	01	01	H3533_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												
H3533	023	0	1	01	01	H3533_023_0	4	Preferred Generic	4	11	3	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	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	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	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	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	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												
H3533	027	0	1	01	01	H3533_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	027	0	1	01	01	H3533_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	027	0	1	01	01	H3533_027_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	027	0	1	01	01	H3533_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												
H3536	002	0	1	01	01	H3536_002_0	6	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																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	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	01	1	2	6	1		111	01	110		1				30	60	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	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	01	1	2	6	3		111	01	110		1				30	60	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	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	5	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	5	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								13.00	26.00	39.00					13.00	26.00	39.00					13.00		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												
H3536	004	0	1	01	01	H3536_004_0	5	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H3536	004	0	1	01	01	H3536_004_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	5	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3536	005	0	1	01	01	H3536_005_0	6	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																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	005	0	1	01	01	H3536_005_0	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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	005	0	1	01	01	H3536_005_0	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	005	0	1	01	01	H3536_005_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	005	0	1	01	01	H3536_005_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	005	0	1	01	01	H3536_005_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	005	0	1	01	01	H3536_005_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	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												
H3561	001	0	1	01	01	H3561_001_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																			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												
H3561	001	0	1	01	01	H3561_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	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												
H3561	001	0	1	01	01	H3561_001_0	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												
H3561	001	0	1	01	01	H3561_001_0	5	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, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	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												
H3561	002	0	1	01	01	H3561_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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_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																			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												
H3561	002	0	1	01	01	H3561_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																			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												
H3561	002	0	1	01	01	H3561_002_0	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												
H3561	002	0	1	01	01	H3561_002_0	5	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, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	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												
H3561	004	0	1	01	01	H3561_004_0	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												
H3561	004	0	1	01	01	H3561_004_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																			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												
H3561	004	0	1	01	01	H3561_004_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																			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												
H3561	004	0	1	01	01	H3561_004_0	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												
H3561	004	0	1	01	01	H3561_004_0	5	Specialty Tier	3	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, Select Care Drugs												
H3561	004	0	1	01	01	H3561_004_0	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												
H3561	005	0	1	01	01	H3561_005_0	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												
H3561	005	0	1	01	01	H3561_005_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																			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												
H3561	005	0	1	01	01	H3561_005_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																			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												
H3561	005	0	1	01	01	H3561_005_0	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												
H3561	005	0	1	01	01	H3561_005_0	5	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, Select Care Drugs												
H3561	005	0	1	01	01	H3561_005_0	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												
H3561	006	0	1	01	01	H3561_006_0	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												
H3561	006	0	1	01	01	H3561_006_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																			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												
H3561	006	0	1	01	01	H3561_006_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																			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												
H3561	006	0	1	01	01	H3561_006_0	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												
H3561	006	0	1	01	01	H3561_006_0	5	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												
H3561	006	0	1	01	01	H3561_006_0	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												
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				16.22	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				97.42	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				41.54	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				561.61	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								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												
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								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		
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	6	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	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	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	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				602.47	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_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																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	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	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	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				731.18	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	6	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			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				691.95	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3655	032	0	1	01	01	H3655_032_0	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		0.00																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	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	7	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	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00		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												
H3655	033	0	1	01	01	H3655_033_0	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H3655	033	0	1	01	01	H3655_033_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	10	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		0.00																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	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	7	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	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00		0.00																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	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00		24.00																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	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	11	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	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	040	0	1	01	01	H3655_040_0	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		0.00																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	040	0	1	01	01	H3655_040_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		20.00																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												
H3655	040	0	1	01	01	H3655_040_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	040	0	1	01	01	H3655_040_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	040	0	1	01	01	H3655_040_0	11	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	040	0	1	01	01	H3655_040_0	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	040	0	1	01	01	H3655_040_0	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	041	0	1	01	01	H3655_041_0	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00		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	041	0	1	01	01	H3655_041_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	041	0	1	01	01	H3655_041_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	041	0	1	01	01	H3655_041_0	11	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	041	0	1	01	01	H3655_041_0	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	10	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	10	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	10	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 Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	10	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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	029	0	1	02	01	H3660_029_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																					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	10	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	10	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	10	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	10	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	10	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	10	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	10	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	044	0	1	01	01	H3660_044_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																					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	10	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	10	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	10	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	10	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	9	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		5.00																					5.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	9	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	2.00		5.00																					5.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	047	0	1	01	01	H3660_047_0	9	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	9	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	9	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	9	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	9	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	9	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	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 Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	8	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	8	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	048	0	1	02	01	H3660_048_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																					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	8	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	8	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	8	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	8	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	12	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	12	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	12	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	050	0	1	01	01	H3660_050_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																					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	12	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	12	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	12	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	12	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	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												
H3664	017	0	1	02	01	H3664_017_0	4	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	15.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_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	125.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	017	0	1	02	01	H3664_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	275.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				1688.77	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_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 Drug, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	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	20.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_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	125.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_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	275.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				1500.55	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_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 Drug, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_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	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_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 Drug, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_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	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31				1583.36	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	014	0	1	01	01	H3668_014_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																			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	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	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	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																			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	5	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	5	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																			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	5	Preferred Generic	4	11	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	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																			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	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	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	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	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	5	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	016	0	1	01	01	H3668_016_0	5	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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												
H3668	016	0	1	01	01	H3668_016_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	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	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																			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	5	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	5	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																			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	5	Preferred Generic	4	11	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	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																			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	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	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	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	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	5	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												
H3668	018	1	1	01	01	H3668_018_1	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	018	1	1	01	01	H3668_018_1	5	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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												
H3668	018	1	1	01	01	H3668_018_1	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	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_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	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	018	1	1	01	01	H3668_018_1	5	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	018	2	1	01	01	H3668_018_2	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	018	2	1	01	01	H3668_018_2	5	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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												
H3668	018	2	1	01	01	H3668_018_2	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	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_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	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	018	2	1	01	01	H3668_018_2	5	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	018	3	1	01	01	H3668_018_3	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	3	1	01	01	H3668_018_3	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	018	3	1	01	01	H3668_018_3	5	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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												
H3668	018	3	1	01	01	H3668_018_3	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	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	3	1	01	01	H3668_018_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	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	018	3	1	01	01	H3668_018_3	5	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	019	1	1	01	01	H3668_019_1	5	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																			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	019	1	1	01	01	H3668_019_1	5	Preferred Generic	4	11	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	019	1	1	01	01	H3668_019_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																			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	019	1	1	01	01	H3668_019_1	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	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_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	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	019	1	1	01	01	H3668_019_1	5	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												
H3668	019	2	1	01	01	H3668_019_2	5	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																			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	019	2	1	01	01	H3668_019_2	5	Preferred Generic	4	11	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	019	2	1	01	01	H3668_019_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																			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	019	2	1	01	01	H3668_019_2	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	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_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	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	019	2	1	01	01	H3668_019_2	5	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												
H3668	019	3	1	01	01	H3668_019_3	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																			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	019	3	1	01	01	H3668_019_3	6	Preferred Generic	4	11	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	019	3	1	01	01	H3668_019_3	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																			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	019	3	1	01	01	H3668_019_3	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																			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	019	3	1	01	01	H3668_019_3	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	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	3	1	01	01	H3668_019_3	6	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												
H3672	013	0	1	01	01	H3672_013_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	013	0	1	01	01	H3672_013_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	013	0	1	01	01	H3672_013_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	013	0	1	01	01	H3672_013_0	5	Non-Preferred Drug	4	11	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	5	Specialty Tier	4	11	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	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	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	4	Specialty Tier	4	11	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	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	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	4	Specialty Tier	4	11	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	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	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	4	Specialty Tier	4	11	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	8	Preferred Generic	4	11	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		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, Select Care Drugs												
H3706	001	0	1	01	01	H3706_001_0	8	Generic	4	11	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		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, Select Care Drugs												
H3706	001	0	1	01	01	H3706_001_0	8	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		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, Select Care Drugs												
H3706	001	0	1	01	01	H3706_001_0	8	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				40		40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3706	001	0	1	01	01	H3706_001_0	8	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												
H3706	001	0	1	01	01	H3706_001_0	8	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	1				30		90	30		31								10.00		30.00					5.00		0.00											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, Select Care Drugs												
H3706	001	0	1	01	01	H3706_001_0	8	Select Care Drugs	4	11	1	2	6	3		110	01		110	1				30		90	1	1				30		90	30		31								10.00		30.00					5.00		0.00											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, Select Care Drugs										1		
H3706	018	0	1	01	01	H3706_018_0	8	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	1				30		90	30		31								10.00		30.00					5.00		0.00											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												
H3706	018	0	1	01	01	H3706_018_0	8	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	1				30		90	30		31								10.00		30.00					5.00		0.00											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										1		
H3706	018	0	1	01	01	H3706_018_0	8	Generic	4	11	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	8	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	8	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				40		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	018	0	1	01	01	H3706_018_0	8	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1060.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				903.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1055.00	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	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				837.00	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 Drug, 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 Drug, 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 Drug, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_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	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												
H3755	001	0	1	01	01	H3755_001_0	7	Specialty Tier	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 Drug, 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 Drug, 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 Drug, 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 Drug, Specialty Tier												
H3755	004	0	1	01	01	H3755_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		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												
H3755	004	0	1	01	01	H3755_004_0	7	Specialty Tier	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 Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_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	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 Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	6	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 Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	6	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 Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_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	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 Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	6	Specialty Tier	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 Drug, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1011.00	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				2	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				2	2						90	30		31	12.00		36.00																											36.00						12.00				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				2	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				2	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				2	2						90	30		31				823.00	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				2	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				2	2						90	30		31	12.00		36.00																											36.00						24.00				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				2	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				2	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				2	2						90	30		31				867.00	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				2	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				2	2						90	30		31	12.00		36.00																											36.00						24.00				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				2	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				2	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				2	2						90	30		31				760.00	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				2	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				2	2						90	30		31	12.00		36.00																											36.00						12.00				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				2	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				2	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				2	2						90	30		31				776.00	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				2	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				2	2						90	30		31	12.00		36.00																											36.00						12.00				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				2	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				2	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				2	2						90	30		31				885.00	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				2	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				2	2						90	30		31	12.00		36.00																											36.00						12.00				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				2	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				2	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				2	2						90	30		31				915.00	28		28																										28						28			28			28								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				2	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				2	2						90	30		31	12.00		36.00																											36.00						12.00				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				2	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				2	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				2	2						90	30		31				801.00	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				2	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				2	2						90	30		31	12.00		36.00																											36.00						12.00				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				2	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				2	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				2	2						90	30		31				1417.00	28		28																										28						28			28			28								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				2	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				2	2						90	30		31	12.00		36.00																											36.00						12.00				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				2	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				2	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				2	2						90	30		31				923.00	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				2	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				2	2						90	30		31	12.00		36.00																											36.00						12.00				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				2	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				2	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				2	2						90	30		31				635.00	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				2	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				2	2						90	30		31	12.00		36.00																											36.00						12.00				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				2	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				2	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				2	2						90	30		31				753.00	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	11	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, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	11	Preferred Generic	4	01	1	2	1	3	111		01		100	1	30	60	90				1	2						90	30		31	10.00	20.00	0.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3810	003	0	1	01	01	H3810_003_0	11	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, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	11	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, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	11	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, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	11	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, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	11	Select Care Drugs	4	11	1	1	6	1	111		01		100	1	30	60	90				1	2						90	30		31				0.00	0	0	0																										0						0			0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	11	Select Care Drugs	4	11	1	1	6	3	111		01		100	1	30	60	90				1	2						90	30		31				0.00	0	0	0																										0						0			0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3811	002	0	1	01	01	H3811_002_0	6	Preferred Generic	4	11	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		.09						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	002	0	1	01	01	H3811_002_0	6	Generic	4	11	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		.26						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	002	0	1	01	01	H3811_002_0	6	Preferred Brand	4	11	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, Select Care Drugs												
H3811	002	0	1	01	01	H3811_002_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	34	60	90				1	2			90				34		31				99.47	48	48	48																				48															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	002	0	1	01	01	H3811_002_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	34														34		31				2192.17	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	002	0	1	01	01	H3811_002_0	6	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	34	60	90				1	2			90				34		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												
H3811	009	0	1	01	01	H3811_009_0	7	Preferred Generic	4	11	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, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	7	Preferred Generic	4	11	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, Select Care Drugs										1		
H3811	009	0	1	01	01	H3811_009_0	7	Generic	4	11	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, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	7	Generic	4	11	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, Select Care Drugs										1		
H3811	009	0	1	01	01	H3811_009_0	7	Preferred Brand	4	11	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, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	34	60	90				1	2			90				34		31				65.49	50	50	50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	34														34		31				1280.37	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	7	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	34	60	90				1	2			90				34		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												
H3811	009	0	1	01	01	H3811_009_0	7	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	34	60	90				1	2			90				34		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		
H3813	006	0	1	04	01	H3813_006_0	10	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	10	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	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												
H3813	006	0	1	04	01	H3813_006_0	10	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	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												
H3813	007	0	1	04	01	H3813_007_0	10	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	007	0	1	04	01	H3813_007_0	10	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	007	0	1	04	01	H3813_007_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												
H3813	007	0	1	04	01	H3813_007_0	10	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	007	0	1	04	01	H3813_007_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												
H3813	008	0	1	04	01	H3813_008_0	10	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	008	0	1	04	01	H3813_008_0	10	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	008	0	1	04	01	H3813_008_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												
H3813	008	0	1	04	01	H3813_008_0	10	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	008	0	1	04	01	H3813_008_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												
H3813	009	0	1	04	01	H3813_009_0	10	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	009	0	1	04	01	H3813_009_0	10	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	009	0	1	04	01	H3813_009_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												
H3813	009	0	1	04	01	H3813_009_0	10	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	009	0	1	04	01	H3813_009_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												
H3815	001	0	1	01	01	H3815_001_0	4	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	4	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	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	001	0	1	01	01	H3815_001_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	001	0	1	01	01	H3815_001_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	001	0	1	01	01	H3815_001_0	4	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1703.16	33						1703.16	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	4	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	4	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	01	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	01	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	01	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	01	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	01	01	H3815_006_0	4	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											2521.76	33						2521.76	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	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	01	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	15.00																	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	120.00																	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	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												
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											1497.67	33						1497.67	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	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	008	0	1	01	01	H3815_008_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	008	0	1	01	01	H3815_008_0	4	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	4	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	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	008	0	1	01	01	H3815_008_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	008	0	1	01	01	H3815_008_0	4	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											2013.84	33						2013.84	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	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	008	0	1	01	01	H3815_008_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	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	15.00																	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	30.00																	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	1	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31											102.55	25	25	25				102.55	25	25	25				25	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	Non-Preferred Brand	2	11	1	1	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31											92.61	25	25	25				92.61	25	25	25				25	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	Specialty Tier	2	11	1	1	5	1		010	10	010		1				30					30							10	31											1236.04	25						1236.04	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	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	010	0	1	01	01	H3815_010_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	010	0	1	01	01	H3815_010_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	010	0	1	01	01	H3815_010_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	010	0	1	01	01	H3815_010_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	010	0	1	01	01	H3815_010_0	5	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											405.43	33						405.43	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	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	010	0	1	01	01	H3815_010_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	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											2112.73	33						2112.73	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	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	013	0	1	01	01	H3815_013_0	4	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	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	013	0	1	01	01	H3815_013_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	013	0	1	01	01	H3815_013_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	013	0	1	01	01	H3815_013_0	4	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											342.56	33						342.56	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	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	013	0	1	01	01	H3815_013_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	015	0	1	01	01	H3815_015_0	4	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	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												
H3815	015	0	1	01	01	H3815_015_0	4	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	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										1		
H3815	015	0	1	01	01	H3815_015_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	15.00																	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	015	0	1	01	01	H3815_015_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	90.00																	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	015	0	1	01	01	H3815_015_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	225.00																	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	015	0	1	01	01	H3815_015_0	4	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1830.64	33						1830.64	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	015	0	1	01	01	H3815_015_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								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	015	0	1	01	01	H3815_015_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								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	016	0	1	01	01	H3815_016_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	016	0	1	01	01	H3815_016_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	016	0	1	01	01	H3815_016_0	4	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	9.00																	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	016	0	1	01	01	H3815_016_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	90.00																	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	016	0	1	01	01	H3815_016_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	225.00																	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	016	0	1	01	01	H3815_016_0	4	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1703.16	33						1703.16	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_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	016	0	1	01	01	H3815_016_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		
H3817	008	1	1	04	01	H3817_008_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												
H3817	008	1	1	04	01	H3817_008_1	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	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												
H3817	008	1	1	04	01	H3817_008_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												
H3817	008	1	1	04	01	H3817_008_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1352.40	28						1352.40	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_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												
H3817	008	2	1	04	01	H3817_008_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	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												
H3817	008	2	1	04	01	H3817_008_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												
H3817	008	2	1	04	01	H3817_008_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1352.40	28						1352.40	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	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												
H3817	009	1	1	04	01	H3817_009_1	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												
H3817	009	1	1	04	01	H3817_009_1	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												
H3817	009	1	1	04	01	H3817_009_1	9	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1593.90	33						1593.90	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	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												
H3817	009	2	1	04	01	H3817_009_2	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												
H3817	009	2	1	04	01	H3817_009_2	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												
H3817	009	2	1	04	01	H3817_009_2	9	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1593.90	33						1593.90	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	1	1	04	01	H3817_011_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												
H3817	011	1	1	04	01	H3817_011_1	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	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												
H3817	011	1	1	04	01	H3817_011_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												
H3817	011	1	1	04	01	H3817_011_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	1	1	04	01	H3817_011_1	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1304.10	27						1304.10	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	2	1	04	01	H3817_011_2	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												
H3817	011	2	1	04	01	H3817_011_2	9	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					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												
H3817	011	2	1	04	01	H3817_011_2	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												
H3817	011	2	1	04	01	H3817_011_2	9	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	2	1	04	01	H3817_011_2	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1304.10	27						1304.10	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	8	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	8	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	8	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	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												
H3822	001	0	1	01	01	H3822_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												
H3822	001	0	1	01	01	H3822_001_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					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	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												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	9	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	9	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	9	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	9	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	9	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	9	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					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	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												33		33					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	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												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	011	0	1	01	01	H3822_011_0	8	Preferred Generic	3	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	011	0	1	01	01	H3822_011_0	8	Generic	3	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						39.00				18.00				18.00			0.60	0.43				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	011	0	1	01	01	H3822_011_0	8	Preferred Brand	3	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												
H3822	011	0	1	01	01	H3822_011_0	8	Non-Preferred Brand	3	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	011	0	1	01	01	H3822_011_0	8	Specialty Tier	3	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												31		31					31		31												31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	007	0	1	04	01	H3832_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	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	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	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	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	007	0	1	04	01	H3832_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		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	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	008	0	1	04	01	H3832_008_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	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	7	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	7	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	7	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	7	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	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												
H3832	009	0	1	04	01	H3832_009_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.50	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	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	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	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																			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	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																			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	6	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	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	6.00				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	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	24.00				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	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	74.00				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	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	74.00				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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.63	33	33	33				49.01	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	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	006	0	1	01	01	H3864_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		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	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	014	0	1	02	01	H3864_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								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 Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_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											17.00	34.00	51.00				12.00	24.00	24.00				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	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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	4	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	74.00				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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.75	33	33	33				47.38	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	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												
H3864	014	0	1	02	01	H3864_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		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	4	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	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 Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_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											17.00	34.00	51.00				12.00	24.00	24.00				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	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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	4	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	74.00				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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.64	33	33	33				46.35	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	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, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	4	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	4	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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 Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				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	4	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	4	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											49.87	33	33	33				45.64	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	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, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	4	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	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	4	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	100	1	2				30	60	100	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	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 Drug, Specialty Tier, Select Care Drugs												
H3864	026	1	1	01	01	H3864_026_1	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	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				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	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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	5	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	74.00				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	5	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	33	33	33				52.47	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	5	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	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	0.00				0.00				0.00			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	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	0.00				0.00				0.00			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	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 Drug, Specialty Tier, Select Care Drugs												
H3864	026	2	1	01	01	H3864_026_2	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											17.00	34.00	51.00				12.00	24.00	24.00				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	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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	4	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	74.00				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	4	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	33	33	33				52.47	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	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, Select Care Drugs												
H3864	026	2	1	01	01	H3864_026_2	4	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	4	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	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	6.00				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	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	24.00				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	027	0	1	01	01	H3864_027_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	74.00				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	8	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.90	33	33	33				53.24	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	8	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												
H3864	027	0	1	01	01	H3864_027_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	027	0	1	01	01	H3864_027_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	029	0	1	01	01	H3864_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					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 Drug, Specialty Tier, Select Care Drugs												
H3864	029	0	1	01	01	H3864_029_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	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				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	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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											54.20	33	33	33				49.59	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	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, Select Care Drugs												
H3864	029	0	1	01	01	H3864_029_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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	029	0	1	01	01	H3864_029_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	0.00				0.00				0.00			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	5	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	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 Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				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	5	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	5	Preferred Brand	4	10	1	2	3	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											54.76	33	33	33				50.13	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	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, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	5	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	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	5	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	100	1	2				30	60	100	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	033	0	1	01	01	H3864_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								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 Drug, Specialty Tier, Select Care Drugs												
H3864	033	0	1	01	01	H3864_033_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											17.00	34.00	51.00				12.00	24.00	24.00				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	033	0	1	01	01	H3864_033_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	033	0	1	01	01	H3864_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											53.58	33	33	33				49.03	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	033	0	1	01	01	H3864_033_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												
H3864	033	0	1	01	01	H3864_033_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	033	0	1	01	01	H3864_033_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	034	0	1	01	01	H3864_034_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 Drug, Specialty Tier, Select Care Drugs												
H3864	034	0	1	01	01	H3864_034_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											17.00	34.00	51.00				12.00	24.00	24.00				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	034	0	1	01	01	H3864_034_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	034	0	1	01	01	H3864_034_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											54.28	33	33	33				49.67	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	034	0	1	01	01	H3864_034_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												
H3864	034	0	1	01	01	H3864_034_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	034	0	1	01	01	H3864_034_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	036	0	1	01	01	H3864_036_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 Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_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											17.00	34.00	51.00				12.00	24.00	24.00				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	036	0	1	01	01	H3864_036_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	036	0	1	01	01	H3864_036_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											49.43	33	33	33				45.22	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	036	0	1	01	01	H3864_036_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												
H3864	036	0	1	01	01	H3864_036_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	037	0	1	01	01	H3864_037_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					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 Drug, Specialty Tier, Select Care Drugs												
H3864	037	0	1	01	01	H3864_037_0	6	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	24.00				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	037	0	1	01	01	H3864_037_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	037	0	1	01	01	H3864_037_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											52.77	33	33	33				48.29	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	037	0	1	01	01	H3864_037_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, Select Care Drugs												
H3864	037	0	1	01	01	H3864_037_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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	037	0	1	01	01	H3864_037_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	0.00				0.00				0.00			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	038	0	1	01	01	H3864_038_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											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H3864	038	0	1	01	01	H3864_038_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											17.00	34.00	51.00				12.00	24.00	24.00				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	038	0	1	01	01	H3864_038_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	038	0	1	01	01	H3864_038_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											52.54	33	33	33				48.07	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	038	0	1	01	01	H3864_038_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, Select Care Drugs												
H3864	038	0	1	01	01	H3864_038_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	038	0	1	01	01	H3864_038_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	039	0	1	01	01	H3864_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								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H3864	039	0	1	01	01	H3864_039_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											17.00	34.00	51.00				12.00	24.00	24.00				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	039	0	1	01	01	H3864_039_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	039	0	1	01	01	H3864_039_0	4	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	74.00				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	039	0	1	01	01	H3864_039_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											53.27	33	33	33				48.68	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	039	0	1	01	01	H3864_039_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, Select Care Drugs												
H3864	039	0	1	01	01	H3864_039_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	039	0	1	01	01	H3864_039_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								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	040	0	1	01	01	H3864_040_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	23.00					3.00	6.00	9.00											8.00	16.00	23.00				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 Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	6	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	24.00				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	040	0	1	01	01	H3864_040_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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	040	0	1	01	01	H3864_040_0	6	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	74.00				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	040	0	1	01	01	H3864_040_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											52.78	33	33	33				48.28	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	040	0	1	01	01	H3864_040_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, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_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	0.00				0.00				0.00			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	10	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	10	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	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	70.50	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	10	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												
H3890	001	0	1	04	01	H3890_001_0	10	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												
H3890	002	0	1	04	01	H3890_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	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	9	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	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																			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												
H3890	002	0	1	04	01	H3890_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		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												
H3890	002	0	1	04	01	H3890_002_0	9	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												
H3907	006	0	1	01	01	H3907_006_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	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							285.00																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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											434.59	33						644.06	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	029	0	1	01	01	H3907_029_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	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							285.00																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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											407.03	33						594.67	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	037	0	1	01	01	H3907_037_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	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							285.00																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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											426.25	33						600.33	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	042	0	1	01	01	H3907_042_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	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							285.00																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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											403.51	33						594.70	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	043	0	1	01	01	H3907_043_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	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							285.00																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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											429.91	33						601.55	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	044	0	1	01	01	H3907_044_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	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							285.00																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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											429.91	33						601.55	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	045	0	1	01	01	H3907_045_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	5	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											42.78	50		50				41.48	45		45						45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	045	0	1	01	01	H3907_045_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											522.87	33						693.51	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	046	0	1	01	01	H3907_046_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	5	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											42.78	50		50				41.48	45		45						45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	046	0	1	01	01	H3907_046_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											522.87	33						693.51	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	047	0	1	01	01	H3907_047_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	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							285.00																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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											403.51	33						594.70	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	048	0	1	01	01	H3907_048_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	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							285.00																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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											403.51	33						594.70	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_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							0.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_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		20.00							20.00																16.00				16.00			0.53	0.33				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_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		105.00							105.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_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							285.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											403.51	33						594.70	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_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							0.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_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		20.00							20.00																16.00				16.00			0.53	0.33				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_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		105.00							105.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											42.78	50		50				41.48	45		45						45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											522.87	33						693.51	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_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							0.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_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		20.00							20.00																16.00				16.00			0.53	0.33				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_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		105.00							105.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											42.78	50		50				41.48	45		45						45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											522.87	33						693.51	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_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							0.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_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		20.00							20.00																16.00				16.00			0.53	0.33				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_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		105.00							105.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											42.78	50		50				41.48	45		45						45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_0	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											522.87	33						693.51	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	17	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					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	17	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					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	17	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	17	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	17	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												
H3909	009	0	1	04	01	H3909_009_0	8	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					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_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					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_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								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	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					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	8	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												
H3916	001	0	1	04	01	H3916_001_0	8	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	8	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	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1148.33	33						1148.33	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	8	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	8	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	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1196.90	33						1196.90	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	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	8	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	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1222.25	33						1222.25	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1149.99	33						1149.99	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											949.44	33						949.44	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1254.82	33						1254.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1028.72	33						1028.72	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1010.61	33						1010.61	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1142.28	33						1142.28	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											941.52	33						941.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											941.52	33						941.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											941.52	33						941.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	8	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	5	1	04	01	H3916_034_5	8	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	5	1	04	01	H3916_034_5	8	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	5	1	04	01	H3916_034_5	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											941.52	33						941.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											871.31	33						871.31	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											871.31	33						871.31	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1352.17	33						1352.17	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_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					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	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											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	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					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	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					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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											626.08	33						626.08	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_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											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	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											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	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					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	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					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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											546.22	33						546.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3924	059	10	1	04	01	H3924_059_10	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 Brand, Specialty Tier												
H3924	059	10	1	04	01	H3924_059_10	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 Brand, Specialty Tier										1		
H3924	059	10	1	04	01	H3924_059_10	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	10	1	04	01	H3924_059_10	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	10	1	04	01	H3924_059_10	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	10	1	04	01	H3924_059_10	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												
H3924	059	11	1	04	01	H3924_059_11	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 Brand, Specialty Tier												
H3924	059	11	1	04	01	H3924_059_11	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 Brand, Specialty Tier										1		
H3924	059	11	1	04	01	H3924_059_11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	11	1	04	01	H3924_059_11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	11	1	04	01	H3924_059_11	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	11	1	04	01	H3924_059_11	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												
H3924	059	12	1	04	01	H3924_059_12	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 Brand, Specialty Tier												
H3924	059	12	1	04	01	H3924_059_12	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 Brand, Specialty Tier										1		
H3924	059	12	1	04	01	H3924_059_12	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	12	1	04	01	H3924_059_12	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	12	1	04	01	H3924_059_12	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	12	1	04	01	H3924_059_12	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												
H3924	059	13	1	04	01	H3924_059_13	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 Brand, Specialty Tier												
H3924	059	13	1	04	01	H3924_059_13	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 Brand, Specialty Tier										1		
H3924	059	13	1	04	01	H3924_059_13	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	13	1	04	01	H3924_059_13	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	13	1	04	01	H3924_059_13	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	13	1	04	01	H3924_059_13	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												
H3924	059	14	1	04	01	H3924_059_14	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 Brand, Specialty Tier												
H3924	059	14	1	04	01	H3924_059_14	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 Brand, Specialty Tier										1		
H3924	059	14	1	04	01	H3924_059_14	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	14	1	04	01	H3924_059_14	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	14	1	04	01	H3924_059_14	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	14	1	04	01	H3924_059_14	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												
H3924	059	15	1	04	01	H3924_059_15	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 Brand, Specialty Tier												
H3924	059	15	1	04	01	H3924_059_15	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 Brand, Specialty Tier										1		
H3924	059	15	1	04	01	H3924_059_15	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	15	1	04	01	H3924_059_15	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	15	1	04	01	H3924_059_15	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	15	1	04	01	H3924_059_15	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												
H3924	059	16	1	04	01	H3924_059_16	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 Brand, Specialty Tier												
H3924	059	16	1	04	01	H3924_059_16	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 Brand, Specialty Tier										1		
H3924	059	16	1	04	01	H3924_059_16	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	16	1	04	01	H3924_059_16	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	16	1	04	01	H3924_059_16	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	16	1	04	01	H3924_059_16	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												
H3924	059	17	1	04	01	H3924_059_17	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 Brand, Specialty Tier												
H3924	059	17	1	04	01	H3924_059_17	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 Brand, Specialty Tier										1		
H3924	059	17	1	04	01	H3924_059_17	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	17	1	04	01	H3924_059_17	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	17	1	04	01	H3924_059_17	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	17	1	04	01	H3924_059_17	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												
H3924	059	18	1	04	01	H3924_059_18	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 Brand, Specialty Tier												
H3924	059	18	1	04	01	H3924_059_18	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 Brand, Specialty Tier										1		
H3924	059	18	1	04	01	H3924_059_18	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	18	1	04	01	H3924_059_18	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	18	1	04	01	H3924_059_18	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	18	1	04	01	H3924_059_18	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												
H3924	060	10	1	04	01	H3924_060_10	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 Brand, Specialty Tier												
H3924	060	10	1	04	01	H3924_060_10	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 Brand, Specialty Tier										1		
H3924	060	10	1	04	01	H3924_060_10	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	10	1	04	01	H3924_060_10	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	10	1	04	01	H3924_060_10	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	10	1	04	01	H3924_060_10	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												
H3924	060	11	1	04	01	H3924_060_11	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 Brand, Specialty Tier												
H3924	060	11	1	04	01	H3924_060_11	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 Brand, Specialty Tier										1		
H3924	060	11	1	04	01	H3924_060_11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	11	1	04	01	H3924_060_11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	11	1	04	01	H3924_060_11	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	11	1	04	01	H3924_060_11	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												
H3924	060	12	1	04	01	H3924_060_12	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 Brand, Specialty Tier												
H3924	060	12	1	04	01	H3924_060_12	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 Brand, Specialty Tier										1		
H3924	060	12	1	04	01	H3924_060_12	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	12	1	04	01	H3924_060_12	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	12	1	04	01	H3924_060_12	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	12	1	04	01	H3924_060_12	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												
H3924	060	13	1	04	01	H3924_060_13	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 Brand, Specialty Tier												
H3924	060	13	1	04	01	H3924_060_13	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 Brand, Specialty Tier										1		
H3924	060	13	1	04	01	H3924_060_13	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	13	1	04	01	H3924_060_13	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	13	1	04	01	H3924_060_13	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	13	1	04	01	H3924_060_13	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												
H3924	060	14	1	04	01	H3924_060_14	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 Brand, Specialty Tier												
H3924	060	14	1	04	01	H3924_060_14	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 Brand, Specialty Tier										1		
H3924	060	14	1	04	01	H3924_060_14	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	14	1	04	01	H3924_060_14	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	14	1	04	01	H3924_060_14	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	14	1	04	01	H3924_060_14	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												
H3924	060	15	1	04	01	H3924_060_15	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 Brand, Specialty Tier												
H3924	060	15	1	04	01	H3924_060_15	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 Brand, Specialty Tier										1		
H3924	060	15	1	04	01	H3924_060_15	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	15	1	04	01	H3924_060_15	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	15	1	04	01	H3924_060_15	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	15	1	04	01	H3924_060_15	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												
H3924	060	16	1	04	01	H3924_060_16	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 Brand, Specialty Tier												
H3924	060	16	1	04	01	H3924_060_16	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 Brand, Specialty Tier										1		
H3924	060	16	1	04	01	H3924_060_16	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	16	1	04	01	H3924_060_16	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	16	1	04	01	H3924_060_16	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	16	1	04	01	H3924_060_16	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												
H3924	060	17	1	04	01	H3924_060_17	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 Brand, Specialty Tier												
H3924	060	17	1	04	01	H3924_060_17	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 Brand, Specialty Tier										1		
H3924	060	17	1	04	01	H3924_060_17	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	17	1	04	01	H3924_060_17	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	17	1	04	01	H3924_060_17	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	17	1	04	01	H3924_060_17	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												
H3924	060	18	1	04	01	H3924_060_18	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 Brand, Specialty Tier												
H3924	060	18	1	04	01	H3924_060_18	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 Brand, Specialty Tier										1		
H3924	060	18	1	04	01	H3924_060_18	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	18	1	04	01	H3924_060_18	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	18	1	04	01	H3924_060_18	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	18	1	04	01	H3924_060_18	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												
H3924	062	10	1	04	01	H3924_062_10	3	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 Brand, Specialty Tier												
H3924	062	10	1	04	01	H3924_062_10	3	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 Brand, Specialty Tier										1		
H3924	062	10	1	04	01	H3924_062_10	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	10	1	04	01	H3924_062_10	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	10	1	04	01	H3924_062_10	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	10	1	04	01	H3924_062_10	3	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												
H3924	062	11	1	04	01	H3924_062_11	3	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 Brand, Specialty Tier												
H3924	062	11	1	04	01	H3924_062_11	3	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 Brand, Specialty Tier										1		
H3924	062	11	1	04	01	H3924_062_11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	11	1	04	01	H3924_062_11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	11	1	04	01	H3924_062_11	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	11	1	04	01	H3924_062_11	3	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												
H3924	062	12	1	04	01	H3924_062_12	3	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 Brand, Specialty Tier												
H3924	062	12	1	04	01	H3924_062_12	3	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 Brand, Specialty Tier										1		
H3924	062	12	1	04	01	H3924_062_12	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	12	1	04	01	H3924_062_12	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	12	1	04	01	H3924_062_12	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	12	1	04	01	H3924_062_12	3	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												
H3924	062	13	1	04	01	H3924_062_13	3	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 Brand, Specialty Tier												
H3924	062	13	1	04	01	H3924_062_13	3	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 Brand, Specialty Tier										1		
H3924	062	13	1	04	01	H3924_062_13	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	13	1	04	01	H3924_062_13	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	13	1	04	01	H3924_062_13	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	13	1	04	01	H3924_062_13	3	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												
H3924	062	14	1	04	01	H3924_062_14	3	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 Brand, Specialty Tier												
H3924	062	14	1	04	01	H3924_062_14	3	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 Brand, Specialty Tier										1		
H3924	062	14	1	04	01	H3924_062_14	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	14	1	04	01	H3924_062_14	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	14	1	04	01	H3924_062_14	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	14	1	04	01	H3924_062_14	3	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												
H3924	062	15	1	04	01	H3924_062_15	3	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 Brand, Specialty Tier												
H3924	062	15	1	04	01	H3924_062_15	3	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 Brand, Specialty Tier										1		
H3924	062	15	1	04	01	H3924_062_15	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	15	1	04	01	H3924_062_15	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	15	1	04	01	H3924_062_15	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	15	1	04	01	H3924_062_15	3	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												
H3924	062	16	1	04	01	H3924_062_16	3	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 Brand, Specialty Tier												
H3924	062	16	1	04	01	H3924_062_16	3	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 Brand, Specialty Tier										1		
H3924	062	16	1	04	01	H3924_062_16	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	16	1	04	01	H3924_062_16	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	16	1	04	01	H3924_062_16	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	16	1	04	01	H3924_062_16	3	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												
H3924	062	17	1	04	01	H3924_062_17	3	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 Brand, Specialty Tier												
H3924	062	17	1	04	01	H3924_062_17	3	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 Brand, Specialty Tier										1		
H3924	062	17	1	04	01	H3924_062_17	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	17	1	04	01	H3924_062_17	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	17	1	04	01	H3924_062_17	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	17	1	04	01	H3924_062_17	3	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												
H3924	062	18	1	04	01	H3924_062_18	3	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 Brand, Specialty Tier												
H3924	062	18	1	04	01	H3924_062_18	3	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 Brand, Specialty Tier										1		
H3924	062	18	1	04	01	H3924_062_18	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	18	1	04	01	H3924_062_18	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	18	1	04	01	H3924_062_18	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	062	18	1	04	01	H3924_062_18	3	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												
H3928	001	0	1	01	01	H3928_001_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3928	001	0	1	01	01	H3928_001_0	2	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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	2	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	10.00					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		
H3928	001	0	1	01	01	H3928_001_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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												
H3928	002	0	1	01	01	H3928_002_0	2	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	2	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3928	002	0	1	01	01	H3928_002_0	2	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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	2	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	10.00					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		
H3928	002	0	1	01	01	H3928_002_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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												
H3930	001	0	1	01	01	H3930_001_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	001	0	1	01	01	H3930_001_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	001	0	1	01	01	H3930_001_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	001	0	1	01	01	H3930_001_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	001	0	1	01	01	H3930_001_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	002	0	1	01	01	H3930_002_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	002	0	1	01	01	H3930_002_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	002	0	1	01	01	H3930_002_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	002	0	1	01	01	H3930_002_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	002	0	1	01	01	H3930_002_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	003	0	1	01	01	H3930_003_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	003	0	1	01	01	H3930_003_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	003	0	1	01	01	H3930_003_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	003	0	1	01	01	H3930_003_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	003	0	1	01	01	H3930_003_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	004	0	1	01	01	H3930_004_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								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												
H3930	004	0	1	01	01	H3930_004_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	9.00	18.00	27.00																																						9.00			9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	004	0	1	01	01	H3930_004_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	004	0	1	01	01	H3930_004_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3930	004	0	1	01	01	H3930_004_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	004	0	1	01	01	H3931_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								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												
H3931	004	0	1	01	01	H3931_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								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		
H3931	004	0	1	01	01	H3931_004_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3931	004	0	1	01	01	H3931_004_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3931	004	0	1	01	01	H3931_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	004	0	1	01	01	H3931_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												
H3931	004	0	1	01	01	H3931_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												
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								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												
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								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		
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	3	Preferred Generic	4	01	1	2	1	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												
H3931	070	0	1	01	01	H3931_070_0	3	Preferred Generic	4	01	1	2	1	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		
H3931	070	0	1	01	01	H3931_070_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3931	070	0	1	01	01	H3931_070_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3931	070	0	1	01	01	H3931_070_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_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	070	0	1	01	01	H3931_070_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	081	0	1	01	01	H3931_081_0	4	Preferred Generic	4	01	1	2	1	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												
H3931	081	0	1	01	01	H3931_081_0	4	Preferred Generic	4	01	1	2	1	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		
H3931	081	0	1	01	01	H3931_081_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	081	0	1	01	01	H3931_081_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_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	081	0	1	01	01	H3931_081_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	091	0	1	01	01	H3931_091_0	3	Preferred Generic	4	01	1	2	1	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												
H3931	091	0	1	01	01	H3931_091_0	3	Preferred Generic	4	01	1	2	1	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		
H3931	091	0	1	01	01	H3931_091_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	091	0	1	01	01	H3931_091_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_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	091	0	1	01	01	H3931_091_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	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								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												
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								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		
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	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						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	093	0	1	01	01	H3931_093_0	3	Preferred Generic	4	01	1	2	1	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												
H3931	093	0	1	01	01	H3931_093_0	3	Preferred Generic	4	01	1	2	1	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		
H3931	093	0	1	01	01	H3931_093_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	093	0	1	01	01	H3931_093_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	093	0	1	01	01	H3931_093_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	093	0	1	01	01	H3931_093_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	093	0	1	01	01	H3931_093_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												
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								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												
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								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		
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	096	0	1	01	01	H3931_096_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_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	10.00					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		
H3931	096	0	1	01	01	H3931_096_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_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	096	0	1	01	01	H3931_096_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												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	01	01	H3931_098_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	098	0	1	01	01	H3931_098_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	01	01	H3931_098_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	10.00					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		
H3931	098	0	1	01	01	H3931_098_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	01	01	H3931_098_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	098	0	1	01	01	H3931_098_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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	102	0	1	01	01	H3931_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								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												
H3931	102	0	1	01	01	H3931_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								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		
H3931	102	0	1	01	01	H3931_102_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3931	102	0	1	01	01	H3931_102_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3931	102	0	1	01	01	H3931_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	102	0	1	01	01	H3931_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												
H3931	102	0	1	01	01	H3931_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												
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								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												
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								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		
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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	105	0	1	01	01	H3931_105_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_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	10.00					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		
H3931	105	0	1	01	01	H3931_105_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_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	105	0	1	01	01	H3931_105_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	106	0	1	01	01	H3931_106_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			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	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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_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	10.00					20.00			20.00			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	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_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	106	0	1	01	01	H3931_106_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	107	0	1	01	01	H3931_107_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	107	0	1	01	01	H3931_107_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_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	10.00					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		
H3931	107	0	1	01	01	H3931_107_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_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	107	0	1	01	01	H3931_107_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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	31						1.00	31												31						31						31		31								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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	33						1.00	33												33						33						33		33								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								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												
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								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		
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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			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								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 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								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			0.50	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	29						1.00	29												29						29						29		29								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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	29						1.00	29												29						29						29		29								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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			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								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 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								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			0.50	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	125	0	1	01	01	H3931_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	125	0	1	01	01	H3931_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	125	0	1	01	01	H3931_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	10.00					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		
H3931	125	0	1	01	01	H3931_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	125	0	1	01	01	H3931_125_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	125	0	1	01	01	H3931_125_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	126	0	1	01	01	H3931_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								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												
H3931	126	0	1	01	01	H3931_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								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00					11.00			11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	126	0	1	01	01	H3931_126_0	5	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	126	0	1	01	01	H3931_126_0	5	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	126	0	1	01	01	H3931_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	126	0	1	01	01	H3931_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												
H3931	126	0	1	01	01	H3931_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												
H3931	127	0	1	01	01	H3931_127_0	3	Preferred Generic	4	01	1	2	1	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												
H3931	127	0	1	01	01	H3931_127_0	3	Preferred Generic	4	01	1	2	1	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		
H3931	127	0	1	01	01	H3931_127_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3931	127	0	1	01	01	H3931_127_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3931	127	0	1	01	01	H3931_127_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	127	0	1	01	01	H3931_127_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	127	0	1	01	01	H3931_127_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	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								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												
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								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		
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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	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												
H3931	130	0	1	01	01	H3931_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								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		
H3931	130	0	1	01	01	H3931_130_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	130	0	1	01	01	H3931_130_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	130	0	1	01	01	H3931_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	130	0	1	01	01	H3931_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	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	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	131	0	1	01	01	H3931_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	131	0	1	01	01	H3931_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	131	0	1	01	01	H3931_131_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	131	0	1	01	01	H3931_131_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	10.00					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		
H3931	131	0	1	01	01	H3931_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	131	0	1	01	01	H3931_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	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	131	0	1	01	01	H3931_131_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												
H3931	132	0	1	01	01	H3931_132_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	132	0	1	01	01	H3931_132_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	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		
H3931	132	0	1	01	01	H3931_132_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	132	0	1	01	01	H3931_132_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	10.00					20.00			20.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	132	0	1	01	01	H3931_132_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	132	0	1	01	01	H3931_132_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	132	0	1	01	01	H3931_132_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	133	0	1	01	01	H3931_133_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	133	0	1	01	01	H3931_133_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	133	0	1	01	01	H3931_133_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	133	0	1	01	01	H3931_133_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	10.00					20.00			20.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	133	0	1	01	01	H3931_133_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	133	0	1	01	01	H3931_133_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	133	0	1	01	01	H3931_133_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	134	0	1	01	01	H3931_134_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	134	0	1	01	01	H3931_134_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	134	0	1	01	01	H3931_134_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	134	0	1	01	01	H3931_134_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	10.00					20.00			20.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	134	0	1	01	01	H3931_134_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	134	0	1	01	01	H3931_134_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	134	0	1	01	01	H3931_134_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	135	0	1	01	01	H3931_135_0	6	Preferred Generic	4	01	1	2	1	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												
H3931	135	0	1	01	01	H3931_135_0	6	Preferred Generic	4	01	1	2	1	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		
H3931	135	0	1	01	01	H3931_135_0	6	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	135	0	1	01	01	H3931_135_0	6	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	135	0	1	01	01	H3931_135_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	135	0	1	01	01	H3931_135_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	135	0	1	01	01	H3931_135_0	6	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	136	0	1	01	01	H3931_136_0	6	Preferred Generic	4	01	1	2	1	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												
H3931	136	0	1	01	01	H3931_136_0	6	Preferred Generic	4	01	1	2	1	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		
H3931	136	0	1	01	01	H3931_136_0	6	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	136	0	1	01	01	H3931_136_0	6	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	136	0	1	01	01	H3931_136_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	136	0	1	01	01	H3931_136_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	136	0	1	01	01	H3931_136_0	6	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	138	0	1	01	01	H3931_138_0	3	Preferred Generic	4	01	1	2	1	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												
H3931	138	0	1	01	01	H3931_138_0	3	Preferred Generic	4	01	1	2	1	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		
H3931	138	0	1	01	01	H3931_138_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	138	0	1	01	01	H3931_138_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	138	0	1	01	01	H3931_138_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	138	0	1	01	01	H3931_138_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	138	0	1	01	01	H3931_138_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												
H3931	139	0	1	01	01	H3931_139_0	3	Preferred Generic	4	01	1	2	1	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												
H3931	139	0	1	01	01	H3931_139_0	3	Preferred Generic	4	01	1	2	1	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		
H3931	139	0	1	01	01	H3931_139_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	139	0	1	01	01	H3931_139_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	139	0	1	01	01	H3931_139_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	139	0	1	01	01	H3931_139_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	139	0	1	01	01	H3931_139_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												
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				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	14.00					2.00	4.00	4.00											7.00	14.00	14.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	2	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												
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	2	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				100.00				100.00			3.33	3.17		3.33	3.17	3.23	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											721.53	33						742.60	33												33						33					33			33								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				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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	2	2				30	60	90	30		31								10.00	20.00	20.00					5.00	10.00	10.00											10.00	20.00	20.00				5.00	10.00	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, 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	2	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, 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	2	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				100.00				100.00			3.33	3.17		3.33	3.17	3.23	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											749.89	33						657.63	33												33						33					33			33								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								5.00	10.00	10.00					5.00	10.00	10.00											5.00	10.00	10.00				5.00	10.00	10.00				5.00				5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	030	0	1	01	01	H3949_030_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	12.00					1.00	2.00	2.00											6.00	12.00	12.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					10.00	20.00	20.00											15.00	30.00	30.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	6	Preferred Brand	4	11	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											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												
H3949	030	0	1	01	01	H3949_030_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											100.00	200.00	300.00				95.00	190.00	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												
H3949	030	0	1	01	01	H3949_030_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											532.37	27						515.42	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	031	0	1	01	01	H3949_031_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				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	031	0	1	01	01	H3949_031_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					10.00	20.00	20.00											15.00	30.00	30.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	031	0	1	01	01	H3949_031_0	5	Preferred Brand	4	11	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											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												
H3949	031	0	1	01	01	H3949_031_0	5	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											100.00	200.00	300.00				95.00	190.00	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												
H3949	031	0	1	01	01	H3949_031_0	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											688.80	33						708.29	33												33						33					33			33								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								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	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								20.00	40.00	60.00					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	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								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	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								20.00	40.00	60.00					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	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					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			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								20.00	40.00	60.00					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	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	8	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					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_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					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_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					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	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					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	8	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	02	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								9.00	18.00	27.00					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												
H3952	053	0	1	02	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					10.00	20.00	20.00					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 Drug, Specialty Tier												
H3952	053	0	1	02	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	02	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	02	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												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	054	0	1	02	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								9.00	18.00	27.00					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												
H3952	054	0	1	02	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					10.00	20.00	20.00					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 Drug, Specialty Tier												
H3952	054	0	1	02	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	02	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	02	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												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	055	0	1	01	01	H3952_055_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					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												
H3952	055	0	1	01	01	H3952_055_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					10.00	20.00	20.00					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 Drug, Specialty Tier												
H3952	055	0	1	01	01	H3952_055_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	055	0	1	01	01	H3952_055_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	055	0	1	01	01	H3952_055_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	056	0	1	01	01	H3952_056_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					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												
H3952	056	0	1	01	01	H3952_056_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					10.00	20.00	20.00					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 Drug, Specialty Tier												
H3952	056	0	1	01	01	H3952_056_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	056	0	1	01	01	H3952_056_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	056	0	1	01	01	H3952_056_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												
H3954	157	10	1	01	01	H3954_157_10	3	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 Brand, Specialty Tier												
H3954	157	10	1	01	01	H3954_157_10	3	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 Brand, Specialty Tier										1		
H3954	157	10	1	01	01	H3954_157_10	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	10	1	01	01	H3954_157_10	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	10	1	01	01	H3954_157_10	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	10	1	01	01	H3954_157_10	3	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												
H3954	157	11	1	01	01	H3954_157_11	3	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 Brand, Specialty Tier												
H3954	157	11	1	01	01	H3954_157_11	3	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 Brand, Specialty Tier										1		
H3954	157	11	1	01	01	H3954_157_11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	11	1	01	01	H3954_157_11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	11	1	01	01	H3954_157_11	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	11	1	01	01	H3954_157_11	3	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												
H3954	157	12	1	01	01	H3954_157_12	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 Brand, Specialty Tier												
H3954	157	12	1	01	01	H3954_157_12	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 Brand, Specialty Tier										1		
H3954	157	12	1	01	01	H3954_157_12	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	12	1	01	01	H3954_157_12	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	12	1	01	01	H3954_157_12	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	12	1	01	01	H3954_157_12	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												
H3954	157	13	1	01	01	H3954_157_13	3	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 Brand, Specialty Tier												
H3954	157	13	1	01	01	H3954_157_13	3	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 Brand, Specialty Tier										1		
H3954	157	13	1	01	01	H3954_157_13	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	13	1	01	01	H3954_157_13	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	13	1	01	01	H3954_157_13	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	13	1	01	01	H3954_157_13	3	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												
H3954	157	14	1	01	01	H3954_157_14	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 Brand, Specialty Tier												
H3954	157	14	1	01	01	H3954_157_14	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 Brand, Specialty Tier										1		
H3954	157	14	1	01	01	H3954_157_14	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	14	1	01	01	H3954_157_14	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	14	1	01	01	H3954_157_14	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	14	1	01	01	H3954_157_14	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												
H3954	157	15	1	01	01	H3954_157_15	3	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 Brand, Specialty Tier												
H3954	157	15	1	01	01	H3954_157_15	3	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 Brand, Specialty Tier										1		
H3954	157	15	1	01	01	H3954_157_15	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	15	1	01	01	H3954_157_15	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	15	1	01	01	H3954_157_15	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	15	1	01	01	H3954_157_15	3	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												
H3954	157	16	1	01	01	H3954_157_16	3	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 Brand, Specialty Tier												
H3954	157	16	1	01	01	H3954_157_16	3	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 Brand, Specialty Tier										1		
H3954	157	16	1	01	01	H3954_157_16	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	16	1	01	01	H3954_157_16	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	16	1	01	01	H3954_157_16	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	16	1	01	01	H3954_157_16	3	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												
H3954	157	17	1	01	01	H3954_157_17	3	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 Brand, Specialty Tier												
H3954	157	17	1	01	01	H3954_157_17	3	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 Brand, Specialty Tier										1		
H3954	157	17	1	01	01	H3954_157_17	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	17	1	01	01	H3954_157_17	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	17	1	01	01	H3954_157_17	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	17	1	01	01	H3954_157_17	3	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												
H3954	157	18	1	01	01	H3954_157_18	3	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 Brand, Specialty Tier												
H3954	157	18	1	01	01	H3954_157_18	3	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 Brand, Specialty Tier										1		
H3954	157	18	1	01	01	H3954_157_18	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	18	1	01	01	H3954_157_18	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	18	1	01	01	H3954_157_18	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	18	1	01	01	H3954_157_18	3	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												
H3954	158	10	1	01	01	H3954_158_10	3	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 Brand, Specialty Tier												
H3954	158	10	1	01	01	H3954_158_10	3	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 Brand, Specialty Tier										1		
H3954	158	10	1	01	01	H3954_158_10	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	10	1	01	01	H3954_158_10	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	10	1	01	01	H3954_158_10	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	10	1	01	01	H3954_158_10	3	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												
H3954	158	11	1	01	01	H3954_158_11	3	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 Brand, Specialty Tier												
H3954	158	11	1	01	01	H3954_158_11	3	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 Brand, Specialty Tier										1		
H3954	158	11	1	01	01	H3954_158_11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	11	1	01	01	H3954_158_11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	11	1	01	01	H3954_158_11	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	11	1	01	01	H3954_158_11	3	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												
H3954	158	12	1	01	01	H3954_158_12	3	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 Brand, Specialty Tier												
H3954	158	12	1	01	01	H3954_158_12	3	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 Brand, Specialty Tier										1		
H3954	158	12	1	01	01	H3954_158_12	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	12	1	01	01	H3954_158_12	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	12	1	01	01	H3954_158_12	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	12	1	01	01	H3954_158_12	3	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												
H3954	158	13	1	01	01	H3954_158_13	3	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 Brand, Specialty Tier												
H3954	158	13	1	01	01	H3954_158_13	3	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 Brand, Specialty Tier										1		
H3954	158	13	1	01	01	H3954_158_13	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	13	1	01	01	H3954_158_13	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	13	1	01	01	H3954_158_13	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	13	1	01	01	H3954_158_13	3	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												
H3954	158	14	1	01	01	H3954_158_14	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 Brand, Specialty Tier												
H3954	158	14	1	01	01	H3954_158_14	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 Brand, Specialty Tier										1		
H3954	158	14	1	01	01	H3954_158_14	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	14	1	01	01	H3954_158_14	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	14	1	01	01	H3954_158_14	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	14	1	01	01	H3954_158_14	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												
H3954	158	15	1	01	01	H3954_158_15	3	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 Brand, Specialty Tier												
H3954	158	15	1	01	01	H3954_158_15	3	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 Brand, Specialty Tier										1		
H3954	158	15	1	01	01	H3954_158_15	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	15	1	01	01	H3954_158_15	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	15	1	01	01	H3954_158_15	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	15	1	01	01	H3954_158_15	3	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												
H3954	158	16	1	01	01	H3954_158_16	3	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 Brand, Specialty Tier												
H3954	158	16	1	01	01	H3954_158_16	3	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 Brand, Specialty Tier										1		
H3954	158	16	1	01	01	H3954_158_16	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	16	1	01	01	H3954_158_16	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	16	1	01	01	H3954_158_16	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	16	1	01	01	H3954_158_16	3	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												
H3954	158	17	1	01	01	H3954_158_17	3	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 Brand, Specialty Tier												
H3954	158	17	1	01	01	H3954_158_17	3	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 Brand, Specialty Tier										1		
H3954	158	17	1	01	01	H3954_158_17	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	17	1	01	01	H3954_158_17	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	17	1	01	01	H3954_158_17	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	17	1	01	01	H3954_158_17	3	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												
H3954	158	18	1	01	01	H3954_158_18	3	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 Brand, Specialty Tier												
H3954	158	18	1	01	01	H3954_158_18	3	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 Brand, Specialty Tier										1		
H3954	158	18	1	01	01	H3954_158_18	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	18	1	01	01	H3954_158_18	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	18	1	01	01	H3954_158_18	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	18	1	01	01	H3954_158_18	3	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												
H3954	159	10	1	01	01	H3954_159_10	3	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 Brand, Specialty Tier												
H3954	159	10	1	01	01	H3954_159_10	3	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 Brand, Specialty Tier										1		
H3954	159	10	1	01	01	H3954_159_10	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	10	1	01	01	H3954_159_10	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	10	1	01	01	H3954_159_10	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	10	1	01	01	H3954_159_10	3	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												
H3954	159	11	1	01	01	H3954_159_11	3	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 Brand, Specialty Tier												
H3954	159	11	1	01	01	H3954_159_11	3	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 Brand, Specialty Tier										1		
H3954	159	11	1	01	01	H3954_159_11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	11	1	01	01	H3954_159_11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	11	1	01	01	H3954_159_11	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	11	1	01	01	H3954_159_11	3	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												
H3954	159	12	1	01	01	H3954_159_12	3	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 Brand, Specialty Tier												
H3954	159	12	1	01	01	H3954_159_12	3	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 Brand, Specialty Tier										1		
H3954	159	12	1	01	01	H3954_159_12	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	12	1	01	01	H3954_159_12	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	12	1	01	01	H3954_159_12	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	12	1	01	01	H3954_159_12	3	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												
H3954	159	13	1	01	01	H3954_159_13	3	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 Brand, Specialty Tier												
H3954	159	13	1	01	01	H3954_159_13	3	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 Brand, Specialty Tier										1		
H3954	159	13	1	01	01	H3954_159_13	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	13	1	01	01	H3954_159_13	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	13	1	01	01	H3954_159_13	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	13	1	01	01	H3954_159_13	3	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												
H3954	159	14	1	01	01	H3954_159_14	3	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 Brand, Specialty Tier												
H3954	159	14	1	01	01	H3954_159_14	3	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 Brand, Specialty Tier										1		
H3954	159	14	1	01	01	H3954_159_14	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	14	1	01	01	H3954_159_14	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	14	1	01	01	H3954_159_14	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	14	1	01	01	H3954_159_14	3	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												
H3954	159	15	1	01	01	H3954_159_15	3	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 Brand, Specialty Tier												
H3954	159	15	1	01	01	H3954_159_15	3	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 Brand, Specialty Tier										1		
H3954	159	15	1	01	01	H3954_159_15	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	15	1	01	01	H3954_159_15	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	15	1	01	01	H3954_159_15	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	15	1	01	01	H3954_159_15	3	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												
H3954	159	16	1	01	01	H3954_159_16	3	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 Brand, Specialty Tier												
H3954	159	16	1	01	01	H3954_159_16	3	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 Brand, Specialty Tier										1		
H3954	159	16	1	01	01	H3954_159_16	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	16	1	01	01	H3954_159_16	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	16	1	01	01	H3954_159_16	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	16	1	01	01	H3954_159_16	3	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												
H3954	159	17	1	01	01	H3954_159_17	3	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 Brand, Specialty Tier												
H3954	159	17	1	01	01	H3954_159_17	3	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 Brand, Specialty Tier										1		
H3954	159	17	1	01	01	H3954_159_17	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	17	1	01	01	H3954_159_17	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	17	1	01	01	H3954_159_17	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	17	1	01	01	H3954_159_17	3	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												
H3954	159	18	1	01	01	H3954_159_18	3	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 Brand, Specialty Tier												
H3954	159	18	1	01	01	H3954_159_18	3	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 Brand, Specialty Tier										1		
H3954	159	18	1	01	01	H3954_159_18	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	18	1	01	01	H3954_159_18	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	18	1	01	01	H3954_159_18	3	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	159	18	1	01	01	H3954_159_18	3	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												
H3957	003	0	1	02	01	H3957_003_0	6	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	02	01	H3957_003_0	6	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	02	01	H3957_003_0	6	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	02	01	H3957_003_0	6	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	02	01	H3957_003_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1202.48	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	006	0	1	02	01	H3957_006_0	6	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	02	01	H3957_006_0	6	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	02	01	H3957_006_0	6	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	02	01	H3957_006_0	6	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	02	01	H3957_006_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1096.58	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	020	0	1	02	01	H3957_020_0	6	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	02	01	H3957_020_0	6	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	02	01	H3957_020_0	6	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	02	01	H3957_020_0	6	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	02	01	H3957_020_0	6	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	02	01	H3957_020_0	6	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	02	01	H3957_020_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1451.70	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	021	0	1	02	01	H3957_021_0	6	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	02	01	H3957_021_0	6	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	02	01	H3957_021_0	6	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	02	01	H3957_021_0	6	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	02	01	H3957_021_0	6	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	02	01	H3957_021_0	6	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	02	01	H3957_021_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1129.48	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	02	01	H3957_031_0	7	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	02	01	H3957_031_0	7	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	02	01	H3957_031_0	7	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	02	01	H3957_031_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	02	01	H3957_031_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1010.99	33						1010.99	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	032	0	1	02	01	H3957_032_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													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	02	01	H3957_032_0	6	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	02	01	H3957_032_0	6	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	02	01	H3957_032_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	032	0	1	02	01	H3957_032_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											853.20	33						853.20	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_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													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	6	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	6	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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											870.31	33						870.31	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_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													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	6	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	6	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	6	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	6	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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1040.42	33						1040.42	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											929.11	33						929.11	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	8	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	8	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	8	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	8	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	8	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											929.11	33						929.11	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	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													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	6	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	6	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	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											929.11	33						929.11	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	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													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	5	1	01	01	H3957_042_5	6	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	5	1	01	01	H3957_042_5	6	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	5	1	01	01	H3957_042_5	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											929.11	33						929.11	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	3	Preferred Generic	4	01	1	2	1	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												
H3959	001	0	1	01	01	H3959_001_0	3	Preferred Generic	4	01	1	2	1	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		
H3959	001	0	1	01	01	H3959_001_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3959	001	0	1	01	01	H3959_001_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3959	001	0	1	01	01	H3959_001_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_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	001	0	1	01	01	H3959_001_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	002	0	1	01	01	H3959_002_0	3	Preferred Generic	4	01	1	2	1	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												
H3959	002	0	1	01	01	H3959_002_0	3	Preferred Generic	4	01	1	2	1	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		
H3959	002	0	1	01	01	H3959_002_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3959	002	0	1	01	01	H3959_002_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3959	002	0	1	01	01	H3959_002_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_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	002	0	1	01	01	H3959_002_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	010	0	1	01	01	H3959_010_0	2	Preferred Generic	4	01	1	2	1	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												
H3959	010	0	1	01	01	H3959_010_0	2	Preferred Generic	4	01	1	2	1	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		
H3959	010	0	1	01	01	H3959_010_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3959	010	0	1	01	01	H3959_010_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3959	010	0	1	01	01	H3959_010_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	5	Preferred Generic	4	01	1	2	1	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												
H3959	011	0	1	01	01	H3959_011_0	5	Preferred Generic	4	01	1	2	1	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		
H3959	011	0	1	01	01	H3959_011_0	5	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3959	011	0	1	01	01	H3959_011_0	5	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3959	011	0	1	01	01	H3959_011_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_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	011	0	1	01	01	H3959_011_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	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								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												
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								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		
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	2	Preferred Generic	4	01	1	2	1	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												
H3959	033	0	1	01	01	H3959_033_0	2	Preferred Generic	4	01	1	2	1	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		
H3959	033	0	1	01	01	H3959_033_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	033	0	1	01	01	H3959_033_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	035	0	1	01	01	H3959_035_0	3	Preferred Generic	3	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	0.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	035	0	1	01	01	H3959_035_0	3	Generic	3	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	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 Drug, Specialty Tier												
H3959	035	0	1	01	01	H3959_035_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																			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	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			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	3	Specialty Tier	3	11	1	1	5	1	010		10	010		1	30								30							10	31				1.00	27																				27																		27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	036	0	1	01	01	H3959_036_0	4	Preferred Generic	3	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	0.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	036	0	1	01	01	H3959_036_0	4	Generic	3	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	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 Drug, Specialty Tier												
H3959	036	0	1	01	01	H3959_036_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	036	0	1	01	01	H3959_036_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	036	0	1	01	01	H3959_036_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	037	0	1	01	01	H3959_037_0	2	Preferred Generic	4	01	1	2	1	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												
H3959	037	0	1	01	01	H3959_037_0	2	Preferred Generic	4	01	1	2	1	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		
H3959	037	0	1	01	01	H3959_037_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	037	0	1	01	01	H3959_037_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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												
H3959	039	0	1	01	01	H3959_039_0	2	Preferred Generic	4	01	1	2	1	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		
H3959	039	0	1	01	01	H3959_039_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3959	039	0	1	01	01	H3959_039_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3959	039	0	1	01	01	H3959_039_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	039	0	1	01	01	H3959_039_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	043	0	1	01	01	H3959_043_0	2	Preferred Generic	4	01	1	2	1	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												
H3959	043	0	1	01	01	H3959_043_0	2	Preferred Generic	4	01	1	2	1	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		
H3959	043	0	1	01	01	H3959_043_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3959	043	0	1	01	01	H3959_043_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3959	043	0	1	01	01	H3959_043_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	043	0	1	01	01	H3959_043_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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												
H3959	045	0	1	01	01	H3959_045_0	2	Preferred Generic	4	01	1	2	1	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		
H3959	045	0	1	01	01	H3959_045_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3959	045	0	1	01	01	H3959_045_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3959	045	0	1	01	01	H3959_045_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	045	0	1	01	01	H3959_045_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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												
H3959	046	0	1	01	01	H3959_046_0	2	Preferred Generic	4	01	1	2	1	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		
H3959	046	0	1	01	01	H3959_046_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3959	046	0	1	01	01	H3959_046_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3959	046	0	1	01	01	H3959_046_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	046	0	1	01	01	H3959_046_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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												
H3959	047	0	1	01	01	H3959_047_0	2	Preferred Generic	4	01	1	2	1	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		
H3959	047	0	1	01	01	H3959_047_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3959	047	0	1	01	01	H3959_047_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3959	047	0	1	01	01	H3959_047_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	047	0	1	01	01	H3959_047_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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												
H3959	049	0	1	01	01	H3959_049_0	2	Preferred Generic	4	01	1	2	1	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		
H3959	049	0	1	01	01	H3959_049_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3959	049	0	1	01	01	H3959_049_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3959	049	0	1	01	01	H3959_049_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	049	0	1	01	01	H3959_049_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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												
H3959	051	0	1	01	01	H3959_051_0	2	Preferred Generic	4	01	1	2	1	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		
H3959	051	0	1	01	01	H3959_051_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H3959	051	0	1	01	01	H3959_051_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H3959	051	0	1	01	01	H3959_051_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	051	0	1	01	01	H3959_051_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	052	0	1	01	01	H3959_052_0	2	Preferred Generic	4	01	1	2	1	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												
H3959	052	0	1	01	01	H3959_052_0	2	Preferred Generic	4	01	1	2	1	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		
H3959	052	0	1	01	01	H3959_052_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	052	0	1	01	01	H3959_052_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	052	0	1	01	01	H3959_052_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	052	0	1	01	01	H3959_052_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	052	0	1	01	01	H3959_052_0	2	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	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											8.00		16.00				3.00		6.00				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	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											8.00		16.00				3.00		6.00				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	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											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												
H3962	001	0	1	01	01	H3962_001_0	3	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		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										1		
H3962	001	0	1	01	01	H3962_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					42.00		126.00											47.00		94.00				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												
H3962	001	0	1	01	01	H3962_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					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												
H3962	001	0	1	01	01	H3962_001_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											668.06	33						668.06	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_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											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	4	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	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					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	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					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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											637.21	33						637.21	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	5	Preferred Generic	4	01	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		12.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_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												
H3962	007	0	1	01	01	H3962_007_0	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											637.85	33						637.85	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	018	0	1	01	01	H3962_018_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					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	4	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	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					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	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					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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											562.02	33						562.02	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	019	0	1	01	01	H3962_019_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											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	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											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	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					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	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					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	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											511.11	33						511.11	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	020	0	1	01	01	H3962_020_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					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	020	0	1	01	01	H3962_020_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											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	020	0	1	01	01	H3962_020_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					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	020	0	1	01	01	H3962_020_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					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	020	0	1	01	01	H3962_020_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											491.80	33						491.80	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3979	001	0	1	01	01	H3979_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												
H3979	001	0	1	01	01	H3979_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		
H3979	001	0	1	01	01	H3979_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					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	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												
H3979	001	0	1	01	01	H3979_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												
H3979	001	0	1	01	01	H3979_001_0	8	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	7	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	009	0	1	01	01	H4003_009_0	7	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	7	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	009	0	1	01	01	H4003_009_0	7	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	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												
H4003	009	0	1	01	01	H4003_009_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	25.00		50.00																					50.00																25.00				25.00		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				145.55	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	02	01	H4003_019_0	8	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	02	01	H4003_019_0	8	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	1
H4003	019	0	1	02	01	H4003_019_0	8	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	02	01	H4003_019_0	8	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	019	0	1	02	01	H4003_019_0	8	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	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												
H4003	019	0	1	02	01	H4003_019_0	8	Non-Preferred Brand	4	10	1	2	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	02	01	H4003_019_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				109.30	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	8	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	8	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	1
H4003	034	0	1	02	01	H4003_034_0	8	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	8	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	034	0	1	02	01	H4003_034_0	8	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	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												
H4003	034	0	1	02	01	H4003_034_0	8	Non-Preferred Brand	4	10	1	2	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				119.28	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	044	0	1	02	01	H4003_044_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	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												
H4003	044	0	1	02	01	H4003_044_0	8	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	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										2		
H4003	044	0	1	02	01	H4003_044_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	044	0	1	02	01	H4003_044_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	044	0	1	02	01	H4003_044_0	8	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	30.00		60.00																					60.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	044	0	1	02	01	H4003_044_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	50.00		100.00																					100.00																50.00				50.00		1.67						1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	044	0	1	02	01	H4003_044_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				115.81	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	045	0	1	02	01	H4003_045_0	7	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	045	0	1	02	01	H4003_045_0	7	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	1
H4003	045	0	1	02	01	H4003_045_0	7	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	045	0	1	02	01	H4003_045_0	7	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	045	0	1	02	01	H4003_045_0	7	Preferred Brand	4	10	1	2	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	045	0	1	02	01	H4003_045_0	7	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	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												
H4003	045	0	1	02	01	H4003_045_0	7	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				116.79	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	056	0	1	02	01	H4004_056_0	9	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	056	0	1	02	01	H4004_056_0	9	Preferred Generic	4	11	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	1
H4004	056	0	1	02	01	H4004_056_0	9	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	056	0	1	02	01	H4004_056_0	9	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4004	056	0	1	02	01	H4004_056_0	9	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	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												
H4004	056	0	1	02	01	H4004_056_0	9	Non-Preferred Brand	4	10	1	2	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	056	0	1	02	01	H4004_056_0	9	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				306.90	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H4005	004	0	1	04	01	H4005_004_0	10	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 Drug, Specialty Tier, Select Care Drugs										1		3
H4005	004	0	1	04	01	H4005_004_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H4005	004	0	1	04	01	H4005_004_0	10	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 Drug, Specialty Tier, Select Care Drugs										1		3
H4005	004	0	1	04	01	H4005_004_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H4005	004	0	1	04	01	H4005_004_0	10	Non-Preferred Drug	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 Drug, Specialty Tier, Select Care Drugs												
H4005	004	0	1	04	01	H4005_004_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H4005	004	0	1	04	01	H4005_004_0	10	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4005	004	0	1	04	01	H4005_004_0	10	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4007	012	0	1	01	01	H4007_012_0	5	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	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	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	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												
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	25.00		50.00																									25.00		75.00				25.00		50.00				25.00				25.00		0.83				0.83	0.83	0.81	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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	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	3	2	1	1	110		01		110	1	30		90				2	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	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	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	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	3	Preferred Generic	3	11	1	1	1	1	110		01	110		1	30		90				2	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	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	3	Preferred Brand	3	11	1	1	3	1	110		01	110		1	30		90				2	2	30		90				30		31				40.00	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	3	Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				54.00	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	3	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	3	Preferred Generic	3	11	1	1	1	1	110		01	110		1	30		90				2	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	3	Generic	3	11	1	1	2	1	110		01	110		1	30		90				2	2	30		90				30		31				4.00	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	3	Preferred Brand	3	11	1	1	3	1	110		01	110		1	30		90				2	2	30		90				30		31				36.00	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	3	Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				47.00	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	3	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	019	0	1	01	01	H4007_019_0	3	Preferred Generic	3	11	1	1	1	1	110		01	110		1	30		90				2	2	30		90				30		31				2.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	019	0	1	01	01	H4007_019_0	3	Generic	3	11	1	1	2	1	110		01	110		1	30		90				2	2	30		90				30		31				4.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	019	0	1	01	01	H4007_019_0	3	Preferred Brand	3	11	1	1	3	1	110		01	110		1	30		90				2	2	30		90				30		31				40.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	019	0	1	01	01	H4007_019_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				52.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	019	0	1	01	01	H4007_019_0	3	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	020	0	1	01	01	H4007_020_0	4	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	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												
H4007	020	0	1	01	01	H4007_020_0	4	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	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												
H4007	020	0	1	01	01	H4007_020_0	4	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	28.00		84.00																									28.00		84.00				28.00		74.00				28.00				28.00		0.93				0.93	0.93	0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	020	0	1	01	01	H4007_020_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	58.00		174.00																									58.00		174.00				58.00		164.00				58.00				58.00		1.93				1.93	1.93	1.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	020	0	1	01	01	H4007_020_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												
H4036	008	0	1	04	01	H4036_008_0	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																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	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	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												
H4036	008	0	1	04	01	H4036_008_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		8.00																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	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	7	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	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		0.00																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	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	7	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	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		0.00																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	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	7	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	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4036	017	0	1	04	01	H4036_017_0	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		0.00																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	017	0	1	04	01	H4036_017_0	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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	017	0	1	04	01	H4036_017_0	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	017	0	1	04	01	H4036_017_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	017	0	1	04	01	H4036_017_0	7	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	017	0	1	04	01	H4036_017_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4089	001	0	1	01	01	H4089_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				811.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4089	002	0	1	01	01	H4089_002_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				989.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	001	0	1	02	01	H4140_001_0	10	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				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												
H4140	001	0	1	02	01	H4140_001_0	10	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	1	30	60	90				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		3
H4140	001	0	1	02	01	H4140_001_0	10	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				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												
H4140	001	0	1	02	01	H4140_001_0	10	Generic	4	11	3	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				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		3
H4140	001	0	1	02	01	H4140_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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	001	0	1	02	01	H4140_001_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	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 Drug, Specialty Tier												
H4140	001	0	1	02	01	H4140_001_0	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				2000.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	002	0	1	02	01	H4140_002_0	10	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				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												
H4140	002	0	1	02	01	H4140_002_0	10	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	1	30	60	90				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		3
H4140	002	0	1	02	01	H4140_002_0	10	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				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												
H4140	002	0	1	02	01	H4140_002_0	10	Generic	4	11	3	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				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		3
H4140	002	0	1	02	01	H4140_002_0	10	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	1	30	60	90				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												
H4140	002	0	1	02	01	H4140_002_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	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 Drug, Specialty Tier												
H4140	002	0	1	02	01	H4140_002_0	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				2000.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	003	0	1	02	01	H4140_003_0	10	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				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												
H4140	003	0	1	02	01	H4140_003_0	10	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	1	30	60	90				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		3
H4140	003	0	1	02	01	H4140_003_0	10	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				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												
H4140	003	0	1	02	01	H4140_003_0	10	Generic	4	11	3	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				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		3
H4140	003	0	1	02	01	H4140_003_0	10	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	1	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												
H4140	003	0	1	02	01	H4140_003_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	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 Drug, Specialty Tier												
H4140	003	0	1	02	01	H4140_003_0	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				2000.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	004	0	1	02	01	H4140_004_0	10	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				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												
H4140	004	0	1	02	01	H4140_004_0	10	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	1	30	60	90				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		3
H4140	004	0	1	02	01	H4140_004_0	10	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				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												
H4140	004	0	1	02	01	H4140_004_0	10	Generic	4	11	3	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				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		3
H4140	004	0	1	02	01	H4140_004_0	10	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	1	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												
H4140	004	0	1	02	01	H4140_004_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	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 Drug, Specialty Tier												
H4140	004	0	1	02	01	H4140_004_0	10	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				2000.00	33	33	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	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												
H4141	003	0	1	01	01	H4141_003_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_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												
H4141	015	0	1	01	01	H4141_015_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												
H4141	015	0	1	01	01	H4141_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_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												
H4141	017	3	1	01	01	H4141_017_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	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												
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	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	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	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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	019	1	1	01	01	H4141_019_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					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	019	1	1	01	01	H4141_019_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	019	1	1	01	01	H4141_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	019	1	1	01	01	H4141_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	019	1	1	01	01	H4141_019_1	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												
H4141	019	2	1	01	01	H4141_019_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					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	019	2	1	01	01	H4141_019_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	019	2	1	01	01	H4141_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	019	2	1	01	01	H4141_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	019	2	1	01	01	H4141_019_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												
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	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	007	0	1	02	01	H4152_007_0	11	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	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	007	0	1	02	01	H4152_007_0	11	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	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	007	0	1	02	01	H4152_007_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	007	0	1	02	01	H4152_007_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	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								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	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								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	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								10.00	20.00	30.00					2.00	4.00	6.00						0.00	0.00																10.00				2.00			0.33	0.07				0.06	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								17.00	34.00	51.00					9.00	18.00	27.00						0.00	0.00																17.00				9.00			0.57	0.30				0.29	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	11	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	11	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	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	018	0	1	02	01	H4152_018_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	018	0	1	02	01	H4152_018_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	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								10.00	20.00	30.00					2.00	4.00	6.00						0.00	0.00																10.00				2.00			0.33	0.07				0.06	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								17.00	34.00	51.00					9.00	18.00	27.00						0.00	0.00																17.00				9.00			0.57	0.30				0.29	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												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	019	2	1	02	01	H4152_019_2	12	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								10.00	20.00	30.00					2.00	4.00	6.00						0.00	0.00																10.00				2.00			0.33	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	019	2	1	02	01	H4152_019_2	12	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								17.00	34.00	51.00					9.00	18.00	27.00						0.00	0.00																17.00				9.00			0.57	0.30				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	019	2	1	02	01	H4152_019_2	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	2	1	02	01	H4152_019_2	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	2	1	02	01	H4152_019_2	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												
H4172	002	0	1	01	01	H4172_002_0	3	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4172	002	0	1	01	01	H4172_002_0	3	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4172	002	0	1	01	01	H4172_002_0	3	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4172	002	0	1	01	01	H4172_002_0	3	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4172	002	0	1	01	01	H4172_002_0	3	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31				2200.00	33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_0	8	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												
H4198	003	0	1	01	01	H4198_003_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	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_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	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_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	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												
H4198	003	0	1	01	01	H4198_003_0	8	Specialty Tier	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 Drug, Specialty Tier												
H4198	005	0	1	01	01	H4198_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	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 Drug, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	9	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 Drug, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	9	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 Drug, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_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	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 Drug, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	9	Specialty Tier	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 Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	8	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 Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	8	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 Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	8	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 Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	8	Non-Preferred Drug	3	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											47.00	50		50				41.00	45		45				45		45															50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	8	Specialty Tier	3	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	28		28				1.00	28		28				28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	8	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 Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	8	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 Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	8	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 Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	8	Non-Preferred Drug	3	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											47.00	50		50				41.00	45		45				45		45															50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	8	Specialty Tier	3	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	28		28				1.00	28		28				28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	8	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 Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	8	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 Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	8	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 Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	8	Non-Preferred Drug	3	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											47.00	50		50				41.00	45		45				45		45															50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	8	Specialty Tier	3	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	28		28				1.00	28		28				28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	6	Generic	2	01	1	2	1	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	Generic, Brand												
H4227	001	0	1	01	01	H4227_001_0	6	Brand	2	10	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				92.28	25	25	25																				25															25			25								Generic, Brand												
H4227	002	0	1	01	01	H4227_002_0	6	Generic	2	01	1	2	1	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	Generic, Brand												
H4227	002	0	1	01	01	H4227_002_0	6	Brand	2	10	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				90.79	25	25	25																				25															25			25								Generic, Brand												
H4236	001	0	1	01	01	H4236_001_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	001	0	1	01	01	H4236_001_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	001	0	1	01	01	H4236_001_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	001	0	1	01	01	H4236_001_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	001	0	1	01	01	H4236_001_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	002	0	1	01	01	H4236_002_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	002	0	1	01	01	H4236_002_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	002	0	1	01	01	H4236_002_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	002	0	1	01	01	H4236_002_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	002	0	1	01	01	H4236_002_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	003	0	1	01	01	H4236_003_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	003	0	1	01	01	H4236_003_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	003	0	1	01	01	H4236_003_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	003	0	1	01	01	H4236_003_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	003	0	1	01	01	H4236_003_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	004	0	1	01	01	H4236_004_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								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												
H4236	004	0	1	01	01	H4236_004_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	9.00	18.00	27.00																																						9.00			9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	004	0	1	01	01	H4236_004_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	004	0	1	01	01	H4236_004_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4236	004	0	1	01	01	H4236_004_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	7	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					2.00		4.00							4.00																9.00				9.00			0.30	0.07				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	7	Generic	2	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								13.00		39.00					6.00		12.00							12.00																13.00				13.00			0.43	0.20				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	7	Preferred Brand	2	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								17.00		51.00					10.00		25.00							25.00																17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	7	Non-Preferred Drug	2	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											51.76	46		46				55.07	46		46						46															46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	7	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31											335.38	25						481.28	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	001	0	1	01	01	H4346_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												
H4346	001	0	1	01	01	H4346_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		
H4346	001	0	1	01	01	H4346_001_0	7	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	7	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	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												
H4346	001	0	1	01	01	H4346_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												
H4346	001	0	1	01	01	H4346_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												
H4346	001	0	1	01	01	H4346_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												
H4346	001	0	1	01	01	H4346_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	
H4346	005	0	1	01	01	H4346_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							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	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		
H4346	005	0	1	01	01	H4346_005_0	7	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	7	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	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												
H4346	005	0	1	01	01	H4346_005_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												
H4346	005	0	1	01	01	H4346_005_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												
H4346	005	0	1	01	01	H4346_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			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	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	
H4346	006	0	1	01	01	H4346_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							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	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		
H4346	006	0	1	01	01	H4346_006_0	7	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	7	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	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												
H4346	006	0	1	01	01	H4346_006_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												
H4346	006	0	1	01	01	H4346_006_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												
H4346	006	0	1	01	01	H4346_006_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												
H4346	006	0	1	01	01	H4346_006_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	
H4346	008	0	1	01	01	H4346_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							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	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		
H4346	008	0	1	01	01	H4346_008_0	7	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	7	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	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												
H4346	008	0	1	01	01	H4346_008_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												
H4346	008	0	1	01	01	H4346_008_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												
H4346	008	0	1	01	01	H4346_008_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												
H4346	008	0	1	01	01	H4346_008_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	
H4346	009	0	1	01	01	H4346_009_0	7	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	7	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	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												
H4346	009	0	1	01	01	H4346_009_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					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	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												
H4346	009	0	1	01	01	H4346_009_0	7	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	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												
H4346	010	0	1	01	01	H4346_010_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		
H4346	010	0	1	01	01	H4346_010_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		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	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		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	7	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	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												
H4346	010	0	1	01	01	H4346_010_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												
H4346	010	0	1	01	01	H4346_010_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												
H4346	010	0	1	01	01	H4346_010_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										2	2	
H4346	012	0	1	01	01	H4346_012_0	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00		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	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H4346	012	0	1	01	01	H4346_012_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	10	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		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	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00		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	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	11	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	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	9	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	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	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								5.00	10.00	15.00					5.00	10.00	15.00					5.00		15.00																5.00				5.00			0.17	0.17	0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	014	0	1	01	01	H4346_014_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												
H4346	014	0	1	01	01	H4346_014_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	9	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	017	0	1	01	01	H4346_017_0	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	017	0	1	01	01	H4346_017_0	11	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4346	017	0	1	01	01	H4346_017_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	017	0	1	01	01	H4346_017_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	017	0	1	01	01	H4346_017_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	017	0	1	01	01	H4346_017_0	11	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												
H4346	018	0	1	01	01	H4346_018_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	018	0	1	01	01	H4346_018_0	9	Preferred Generic	4	01	1	2	1	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4346	018	0	1	01	01	H4346_018_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					9.00	18.00	27.00					9.00		27.00																9.00				9.00			0.30	0.30	0.30			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	018	0	1	01	01	H4346_018_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	018	0	1	01	01	H4346_018_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	018	0	1	01	01	H4346_018_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												
H4407	026	0	1	01	01	H4407_026_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	4.00											7.00	14.00	21.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	026	0	1	01	01	H4407_026_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	20.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	026	0	1	01	01	H4407_026_0	4	Preferred Brand	4	11	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											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												
H4407	026	0	1	01	01	H4407_026_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											47.91	50	50	50				58.44	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	026	0	1	01	01	H4407_026_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											551.69	27						458.96	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_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					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	16.00											13.00	26.00	39.00				8.00	16.00	0.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_0	4	Preferred Brand	4	11	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											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												
H4407	027	0	1	01	01	H4407_027_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											75.07	50	50	50				85.14	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											736.71	33						615.63	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_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												
H4461	022	0	1	01	01	H4461_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_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												
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	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	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	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												33							33												33						33					33			33								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	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	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	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												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	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												
H4461	030	2	1	01	01	H4461_030_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_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												
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	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	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	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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_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												
H4461	031	1	1	01	01	H4461_031_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	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												
H4461	031	2	1	01	01	H4461_031_2	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	2	1	01	01	H4461_031_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	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												
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	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	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	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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	01	01	H4461_034_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												
H4461	034	0	1	01	01	H4461_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	01	01	H4461_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	01	01	H4461_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	01	01	H4461_034_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												
H4461	035	0	1	01	01	H4461_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					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	035	0	1	01	01	H4461_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	01	01	H4461_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	01	01	H4461_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	01	01	H4461_035_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												
H4461	036	0	1	01	01	H4461_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					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	036	0	1	01	01	H4461_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	01	01	H4461_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	01	01	H4461_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	01	01	H4461_036_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												
H4497	001	1	1	04	01	H4497_001_1	26	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	26	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	1	1	04	01	H4497_001_1	26	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	26	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	1	1	04	01	H4497_001_1	26	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	26	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											28.13	50		50				28.13	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	26	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 Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	8	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	8	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	2	1	04	01	H4497_001_2	8	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	8	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	2	1	04	01	H4497_001_2	8	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											28.13	50		50				28.13	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	8	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 Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	8	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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												
H4497	002	1	1	04	01	H4497_002_1	8	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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										1		
H4497	002	1	1	04	01	H4497_002_1	8	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	8	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	1	1	04	01	H4497_002_1	8	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											31.45	50		50				31.45	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	8	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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												
H4497	002	2	1	04	01	H4497_002_2	8	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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										1		
H4497	002	2	1	04	01	H4497_002_2	8	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	8	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	2	1	04	01	H4497_002_2	8	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											31.45	50		50				31.45	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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												
H4497	003	1	1	04	01	H4497_003_1	7	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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										1		
H4497	003	1	1	04	01	H4497_003_1	7	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	7	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	1	1	04	01	H4497_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		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	7	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											22.45	50		50				22.45	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	7	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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												
H4497	003	2	1	04	01	H4497_003_2	7	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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										1		
H4497	003	2	1	04	01	H4497_003_2	7	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	7	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	2	1	04	01	H4497_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		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	7	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											22.45	50		50				22.45	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	7	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	7	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4506	003	0	1	01	01	H4506_003_0	7	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		12.50																									5.00		12.50				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												
H4506	003	0	1	01	01	H4506_003_0	7	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		12.50																									5.00		12.50				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										1		
H4506	003	0	1	01	01	H4506_003_0	7	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		100.00																									40.00		100.00				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												
H4506	003	0	1	01	01	H4506_003_0	7	Preferred Brand	4	11	1	2	3	3	110		01		110	1	30		90				1	2				30		90	30		31	40.00		100.00																									40.00		100.00				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										2	1	
H4506	003	0	1	01	01	H4506_003_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	80.00		200.00																									80.00		200.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_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 Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	8	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	8	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4506	029	0	1	02	01	H4506_029_0	8	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		12.50																									5.00		12.50				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												
H4506	029	0	1	02	01	H4506_029_0	8	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		100.00																									40.00		100.00				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												
H4506	029	0	1	02	01	H4506_029_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	80.00		200.00																									80.00		200.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	8	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												
H4513	025	0	1	01	01	H4513_025_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	5.00					0.00	0.00	0.00											5.00	10.00	5.00				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												
H4513	025	0	1	01	01	H4513_025_0	3	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				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										1		
H4513	025	0	1	01	01	H4513_025_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	9.00					4.00	8.00	4.00											9.00	18.00	9.00				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	025	0	1	01	01	H4513_025_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	90.00					40.00	80.00	80.00											45.00	90.00	90.00				40.00	80.00	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												
H4513	025	0	1	01	01	H4513_025_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	170.00					80.00	160.00	160.00											85.00	170.00	170.00				80.00	160.00	160.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	025	0	1	01	01	H4513_025_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											747.15	33						629.55	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	026	0	1	01	01	H4513_026_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	20.00					3.00	6.00	7.50											8.00	16.00	20.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	026	0	1	01	01	H4513_026_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	32.50					8.00	16.00	20.00											13.00	26.00	32.50				0.00	0.00	0.00				13.00				13.00			0.43	0.27		0.43	0.00	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	026	0	1	01	01	H4513_026_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	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												
H4513	026	0	1	01	01	H4513_026_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								75.00	150.00	225.00					70.00	140.00	210.00											75.00	150.00	225.00				70.00	140.00	210.00				75.00				75.00			2.50	2.33		2.50	2.33	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	026	0	1	01	01	H4513_026_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											747.92	33						596.96	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	028	0	1	01	01	H4513_028_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	20.00					3.00	6.00	7.50											8.00	16.00	20.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	028	0	1	01	01	H4513_028_0	3	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	32.50					8.00	16.00	20.00											13.00	26.00	32.50				0.00	0.00	0.00				13.00				13.00			0.43	0.27		0.43	0.00	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	028	0	1	01	01	H4513_028_0	3	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	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												
H4513	028	0	1	01	01	H4513_028_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								75.00	150.00	225.00					70.00	140.00	210.00											75.00	150.00	225.00				70.00	140.00	210.00				75.00				75.00			2.50	2.33		2.50	2.33	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	028	0	1	01	01	H4513_028_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											792.94	33						584.95	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_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	20.00					3.00	6.00	6.00											10.00	20.00	20.00				3.00	6.00	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												
H4513	030	0	1	01	01	H4513_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	20.00					3.00	6.00	6.00											10.00	20.00	20.00				3.00	6.00	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										1		
H4513	030	0	1	01	01	H4513_030_0	4	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	40.00					12.00	24.00	24.00											20.00	40.00	40.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	4	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	40.00					12.00	24.00	24.00											20.00	40.00	40.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	030	0	1	01	01	H4513_030_0	4	Preferred Brand	4	11	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											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												
H4513	030	0	1	01	01	H4513_030_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											96.00	50	50	50				91.65	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											707.21	29						507.98	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_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				3.00	6.00	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												
H4513	036	0	1	02	01	H4513_036_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				3.00	6.00	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										1		
H4513	036	0	1	02	01	H4513_036_0	4	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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	4	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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	036	0	1	02	01	H4513_036_0	4	Preferred Brand	4	11	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											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												
H4513	036	0	1	02	01	H4513_036_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											92.36	50	50	50				89.05	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											738.38	29						580.11	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_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					2.00	4.00	4.00											10.00	20.00	20.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_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	20.00					2.00	4.00	4.00											10.00	20.00	20.00				2.00	4.00	0.00				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		
H4513	037	0	1	01	01	H4513_037_0	4	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	40.00					10.00	20.00	20.00											20.00	40.00	40.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_0	4	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	40.00					10.00	20.00	20.00											20.00	40.00	40.00				10.00	20.00	0.00				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		
H4513	037	0	1	01	01	H4513_037_0	4	Preferred Brand	4	11	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											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												
H4513	037	0	1	01	01	H4513_037_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.30	49	49	49				96.63	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											736.98	30						534.13	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_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				3.00	6.00	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												
H4513	038	0	1	01	01	H4513_038_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				3.00	6.00	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										1		
H4513	038	0	1	01	01	H4513_038_0	4	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					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	4	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					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	038	0	1	01	01	H4513_038_0	4	Preferred Brand	4	11	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											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												
H4513	038	0	1	01	01	H4513_038_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											72.06	50	50	50				69.42	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											579.78	28						471.45	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	042	0	1	01	01	H4513_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					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	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												
H4513	042	0	1	01	01	H4513_042_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				3.00	6.00	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										1		
H4513	042	0	1	01	01	H4513_042_0	4	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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	042	0	1	01	01	H4513_042_0	4	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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	042	0	1	01	01	H4513_042_0	4	Preferred Brand	4	11	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											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												
H4513	042	0	1	01	01	H4513_042_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.59	46	46	46				99.63	44	44	44										46	46	46				44	44	44			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	042	0	1	01	01	H4513_042_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											844.55	33						536.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	043	0	1	01	01	H4513_043_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				3.00	6.00	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												
H4513	043	0	1	01	01	H4513_043_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				3.00	6.00	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										1		
H4513	043	0	1	01	01	H4513_043_0	4	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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	043	0	1	01	01	H4513_043_0	4	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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	043	0	1	01	01	H4513_043_0	4	Preferred Brand	4	11	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											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												
H4513	043	0	1	01	01	H4513_043_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.03	43	43	43				94.74	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	043	0	1	01	01	H4513_043_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											882.97	33						695.71	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	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					2.00	4.00	4.00											9.00	18.00	27.00				2.00	4.00	0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					8.00	16.00	16.00											15.00	30.00	45.00				8.00	16.00	0.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	4	Preferred Brand	4	11	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											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												
H4513	046	1	1	01	01	H4513_046_1	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											88.84	50	50	50				77.24	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											598.31	29						552.13	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_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					2.00	4.00	4.00											9.00	18.00	27.00				2.00	4.00	0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					8.00	16.00	16.00											15.00	30.00	45.00				8.00	16.00	0.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	4	Preferred Brand	4	11	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											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												
H4513	046	2	1	01	01	H4513_046_2	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											88.84	50	50	50				77.24	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											598.31	29						552.13	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_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					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	16.00											13.00	26.00	39.00				8.00	16.00	0.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_0	4	Preferred Brand	4	11	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											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												
H4513	047	0	1	01	01	H4513_047_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.54	45	45	45				88.01	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											710.55	33						669.44	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	048	0	1	01	01	H4513_048_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					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	048	0	1	01	01	H4513_048_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	16.00											13.00	26.00	39.00				8.00	16.00	0.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	048	0	1	01	01	H4513_048_0	4	Preferred Brand	4	11	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											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												
H4513	048	0	1	01	01	H4513_048_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											96.55	43	43	43				84.69	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	048	0	1	01	01	H4513_048_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											762.96	33						627.15	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	1	1	01	01	H4513_049_1	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				3.00	6.00	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												
H4513	049	1	1	01	01	H4513_049_1	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				3.00	6.00	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										1		
H4513	049	1	1	01	01	H4513_049_1	4	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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	1	1	01	01	H4513_049_1	4	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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	049	1	1	01	01	H4513_049_1	4	Preferred Brand	4	11	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											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												
H4513	049	1	1	01	01	H4513_049_1	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.42	50	50	50				95.33	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	1	1	01	01	H4513_049_1	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											724.09	30						528.35	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	2	1	01	01	H4513_049_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					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	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												
H4513	049	2	1	01	01	H4513_049_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					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	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										1		
H4513	049	2	1	01	01	H4513_049_2	4	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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	2	1	01	01	H4513_049_2	4	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					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	049	2	1	01	01	H4513_049_2	4	Preferred Brand	4	11	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											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												
H4513	049	2	1	01	01	H4513_049_2	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											97.42	50	50	50				95.33	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	2	1	01	01	H4513_049_2	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											724.09	30						528.35	30												30						30					30			30								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				2	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				2	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				2	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				2	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				2	2						90	30		31				776.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	001	0	1	01	01	H4523_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	001	0	1	01	01	H4523_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	001	0	1	01	01	H4523_001_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_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	10.00					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		
H4523	001	0	1	01	01	H4523_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	001	0	1	01	01	H4523_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												
H4523	001	0	1	01	01	H4523_001_0	4	Specialty Tier	4	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												
H4523	015	0	1	01	01	H4523_015_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	015	0	1	01	01	H4523_015_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_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	10.00					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		
H4523	015	0	1	01	01	H4523_015_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_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												
H4523	015	0	1	01	01	H4523_015_0	3	Specialty Tier	4	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												
H4523	020	0	1	01	01	H4523_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								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												
H4523	020	0	1	01	01	H4523_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								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		
H4523	020	0	1	01	01	H4523_020_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H4523	020	0	1	01	01	H4523_020_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H4523	020	0	1	01	01	H4523_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	020	0	1	01	01	H4523_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												
H4523	020	0	1	01	01	H4523_020_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												
H4523	021	0	1	01	01	H4523_021_0	3	Preferred Generic	4	01	1	2	1	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												
H4523	021	0	1	01	01	H4523_021_0	3	Preferred Generic	4	01	1	2	1	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		
H4523	021	0	1	01	01	H4523_021_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H4523	021	0	1	01	01	H4523_021_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H4523	021	0	1	01	01	H4523_021_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_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												
H4523	021	0	1	01	01	H4523_021_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												
H4523	024	0	1	01	01	H4523_024_0	3	Preferred Generic	4	01	1	2	1	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												
H4523	024	0	1	01	01	H4523_024_0	3	Preferred Generic	4	01	1	2	1	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		
H4523	024	0	1	01	01	H4523_024_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H4523	024	0	1	01	01	H4523_024_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H4523	024	0	1	01	01	H4523_024_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_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												
H4523	024	0	1	01	01	H4523_024_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												
H4527	001	0	1	01	01	H4527_001_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				886.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1002.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				843.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1134.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	01	01	H4527_037_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				900.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	038	0	1	01	01	H4527_038_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	038	0	1	01	01	H4527_038_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	038	0	1	01	01	H4527_038_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	038	0	1	01	01	H4527_038_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	038	0	1	01	01	H4527_038_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1007.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				840.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				879.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				967.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1077.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				936.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				736.00	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		100				2	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												
H4604	003	0	1	01	01	H4604_003_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		100				2	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												
H4604	003	0	1	01	01	H4604_003_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	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		100				2	2						100	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		100				2	2						100	30		31				955.00	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		100				2	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												
H4604	011	0	1	01	01	H4604_011_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		100				2	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												
H4604	011	0	1	01	01	H4604_011_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	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		100				2	2						100	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		100				2	2						100	30		31				846.00	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				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		.10						.09	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				2	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												
H4604	012	0	1	01	01	H4604_012_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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				2	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				2	2						90	30		31				631.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				805.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				805.00	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	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												
H4605	002	0	1	04	01	H4605_002_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	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												
H4605	002	0	1	04	01	H4605_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	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												
H4605	002	0	1	04	01	H4605_002_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1352.40	28						1352.40	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_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												
H4605	004	0	1	04	01	H4605_004_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												
H4605	004	0	1	04	01	H4605_004_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												
H4605	004	0	1	04	01	H4605_004_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1593.90	33						1593.90	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	007	0	1	04	01	H4605_007_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												
H4605	007	0	1	04	01	H4605_007_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	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												
H4605	007	0	1	04	01	H4605_007_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												
H4605	007	0	1	04	01	H4605_007_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	007	0	1	04	01	H4605_007_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1304.10	27						1304.10	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_001_0	3	Preferred Generic	4	11	3	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												
H4623	001	0	1	01	01	H4623_001_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_001_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												
H4754	004	0	1	04	01	H4754_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								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 Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_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	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				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	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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	5	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	74.00				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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.10	33	33	33				52.44	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	5	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	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	0.00				0.00				0.00			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	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	0.00				0.00				0.00			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	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											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 Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	6	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	24.00				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	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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	6	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	74.00				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	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.89	33	33	33				55.73	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	6	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	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	0.00				0.00				0.00			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	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	0.00				0.00				0.00			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	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 Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_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	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				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	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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	5	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	74.00				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	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.54	33	33	33				47.21	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	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, Select Care Drugs												
H4754	009	0	1	04	01	H4754_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		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	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	0.00				0.00				0.00			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	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											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 Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	6	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	24.00				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	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					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				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	6	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	74.00				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	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											65.24	33	33	33				59.72	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	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, Select Care Drugs												
H4754	011	0	1	04	01	H4754_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		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	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	0.00				0.00				0.00			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	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	001	0	1	01	01	H4778_001_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	001	0	1	01	01	H4778_001_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	001	0	1	01	01	H4778_001_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	001	0	1	01	01	H4778_001_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	002	0	1	01	01	H4778_002_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	002	0	1	01	01	H4778_002_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	002	0	1	01	01	H4778_002_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	002	0	1	01	01	H4778_002_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	002	0	1	01	01	H4778_002_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	003	0	1	01	01	H4778_003_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	003	0	1	01	01	H4778_003_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	003	0	1	01	01	H4778_003_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	003	0	1	01	01	H4778_003_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	003	0	1	01	01	H4778_003_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	004	0	1	01	01	H4778_004_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								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												
H4778	004	0	1	01	01	H4778_004_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	9.00	18.00	27.00																																						9.00			9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	004	0	1	01	01	H4778_004_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	004	0	1	01	01	H4778_004_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4778	004	0	1	01	01	H4778_004_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4847	001	0	1	01	01	H4847_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	001	0	1	01	01	H4847_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H4847	001	0	1	01	01	H4847_001_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	001	0	1	01	01	H4847_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	001	0	1	01	01	H4847_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				43.93	35		35																								35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	001	0	1	01	01	H4847_001_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												
H4847	002	0	1	01	01	H4847_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	002	0	1	01	01	H4847_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H4847	002	0	1	01	01	H4847_002_0	4	Generic	4	11	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		0.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	002	0	1	01	01	H4847_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	002	0	1	01	01	H4847_002_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				43.94	35		35																								35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	002	0	1	01	01	H4847_002_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												
H4853	001	0	1	01	01	H4853_001_0	9	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		0.00																2.00				2.00		.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	001	0	1	01	01	H4853_001_0	9	Generic	4	11	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	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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	001	0	1	01	01	H4853_001_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	001	0	1	01	01	H4853_001_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				655.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	002	0	1	01	01	H4853_002_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	002	0	1	01	01	H4853_002_0	9	Generic	4	11	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	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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	002	0	1	01	01	H4853_002_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	002	0	1	01	01	H4853_002_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				613.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	003	0	1	02	01	H4853_003_0	9	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		0.00																2.00				2.00		.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	003	0	1	02	01	H4853_003_0	9	Generic	4	11	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	003	0	1	02	01	H4853_003_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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	003	0	1	02	01	H4853_003_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	003	0	1	02	01	H4853_003_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				641.00	32		32																		32		32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	004	0	1	02	01	H4853_004_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	004	0	1	02	01	H4853_004_0	9	Generic	4	11	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	004	0	1	02	01	H4853_004_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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	004	0	1	02	01	H4853_004_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	004	0	1	02	01	H4853_004_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				651.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	001	0	1	01	01	H4868_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	001	0	1	01	01	H4868_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H4868	001	0	1	01	01	H4868_001_0	3	Generic	4	11	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		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	001	0	1	01	01	H4868_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	001	0	1	01	01	H4868_001_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				67.85	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	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												
H4868	002	0	1	01	01	H4868_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	002	0	1	01	01	H4868_002_0	5	Generic	3	11	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		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	002	0	1	01	01	H4868_002_0	5	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												
H4868	002	0	1	01	01	H4868_002_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.08	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	002	0	1	01	01	H4868_002_0	5	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												
H4868	004	0	1	01	01	H4868_004_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	004	0	1	01	01	H4868_004_0	5	Generic	3	11	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		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	004	0	1	01	01	H4868_004_0	5	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												
H4868	004	0	1	01	01	H4868_004_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.49	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	004	0	1	01	01	H4868_004_0	5	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												
H4868	005	3	1	01	01	H4868_005_3	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	005	3	1	01	01	H4868_005_3	4	Generic	3	11	1	2	2	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												
H4868	005	3	1	01	01	H4868_005_3	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		88.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	005	3	1	01	01	H4868_005_3	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.35	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	005	3	1	01	01	H4868_005_3	4	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												
H4868	005	4	1	01	01	H4868_005_4	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	005	4	1	01	01	H4868_005_4	5	Generic	3	11	1	2	2	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												
H4868	005	4	1	01	01	H4868_005_4	5	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		88.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	005	4	1	01	01	H4868_005_4	5	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.35	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	005	4	1	01	01	H4868_005_4	5	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												
H4868	006	3	1	01	01	H4868_006_3	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	006	3	1	01	01	H4868_006_3	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4868	006	3	1	01	01	H4868_006_3	4	Generic	4	11	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		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	006	3	1	01	01	H4868_006_3	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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	006	3	1	01	01	H4868_006_3	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				80.86	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	006	3	1	01	01	H4868_006_3	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												
H4868	006	4	1	01	01	H4868_006_4	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	006	4	1	01	01	H4868_006_4	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4868	006	4	1	01	01	H4868_006_4	4	Generic	4	11	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		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	006	4	1	01	01	H4868_006_4	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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	006	4	1	01	01	H4868_006_4	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				80.86	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	006	4	1	01	01	H4868_006_4	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												
H4868	007	0	1	01	01	H4868_007_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	007	0	1	01	01	H4868_007_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H4868	007	0	1	01	01	H4868_007_0	3	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	007	0	1	01	01	H4868_007_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	007	0	1	01	01	H4868_007_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				69.23	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	007	0	1	01	01	H4868_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												
H4868	008	0	1	01	01	H4868_008_0	3	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												
H4868	008	0	1	01	01	H4868_008_0	3	Generic	4	11	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		0.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	008	0	1	01	01	H4868_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	008	0	1	01	01	H4868_008_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				72.75	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	008	0	1	01	01	H4868_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												
H4868	009	0	1	01	01	H4868_009_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	009	0	1	01	01	H4868_009_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H4868	009	0	1	01	01	H4868_009_0	3	Generic	4	11	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		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	009	0	1	01	01	H4868_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	009	0	1	01	01	H4868_009_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				71.79	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	009	0	1	01	01	H4868_009_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												
H4868	010	0	1	01	01	H4868_010_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	010	0	1	01	01	H4868_010_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H4868	010	0	1	01	01	H4868_010_0	3	Generic	4	11	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		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	010	0	1	01	01	H4868_010_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	010	0	1	01	01	H4868_010_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				74.01	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	010	0	1	01	01	H4868_010_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												
H4868	011	1	1	01	01	H4868_011_1	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	011	1	1	01	01	H4868_011_1	3	Generic	4	11	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		0.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	011	1	1	01	01	H4868_011_1	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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	011	1	1	01	01	H4868_011_1	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				69.78	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	011	1	1	01	01	H4868_011_1	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												
H4868	011	2	1	01	01	H4868_011_2	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	011	2	1	01	01	H4868_011_2	3	Generic	4	11	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		0.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	011	2	1	01	01	H4868_011_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	011	2	1	01	01	H4868_011_2	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				69.78	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	011	2	1	01	01	H4868_011_2	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												
H4868	012	1	1	01	01	H4868_012_1	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	012	1	1	01	01	H4868_012_1	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4868	012	1	1	01	01	H4868_012_1	3	Generic	4	11	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		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	012	1	1	01	01	H4868_012_1	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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	012	1	1	01	01	H4868_012_1	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				67.18	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	012	1	1	01	01	H4868_012_1	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												
H4868	012	2	1	01	01	H4868_012_2	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	012	2	1	01	01	H4868_012_2	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4868	012	2	1	01	01	H4868_012_2	3	Generic	4	11	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		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	012	2	1	01	01	H4868_012_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	012	2	1	01	01	H4868_012_2	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				67.18	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	012	2	1	01	01	H4868_012_2	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												
H4868	013	0	1	01	01	H4868_013_0	3	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												
H4868	013	0	1	01	01	H4868_013_0	3	Generic	4	11	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		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	013	0	1	01	01	H4868_013_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	013	0	1	01	01	H4868_013_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				67.83	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	013	0	1	01	01	H4868_013_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												
H4875	016	1	1	04	01	H4875_016_1	13	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	13	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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											84.57	50	50	50				76.11	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	13	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	13	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	13	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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											84.57	50	50	50				76.11	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	13	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	13	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	13	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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											84.57	50	50	50				76.11	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	13	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	13	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	13	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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											84.57	50	50	50				76.11	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	13	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	13	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	13	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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											84.57	50	50	50				76.11	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	13	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	13	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	13	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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											74.81	45	45	45				66.50	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	13	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	13	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	13	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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											74.81	45	45	45				66.50	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	13	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	13	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	13	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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											74.81	45	45	45				66.50	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	13	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	13	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	13	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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											74.81	45	45	45				66.50	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	13	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	13	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	13	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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											74.81	45	45	45				66.50	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	13	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	13	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	0.00																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	13	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	0.00																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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											83.48	50	50	50				75.13	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	13	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	13	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	0.00																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	13	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	0.00																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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											83.48	50	50	50				75.13	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	13	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	13	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	0.00																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	13	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	0.00																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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											83.48	50	50	50				75.13	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	13	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	13	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	0.00																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	13	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	0.00																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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											83.48	50	50	50				75.13	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	13	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	13	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	0.00																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	13	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	0.00																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	13	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	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											83.48	50	50	50				75.13	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	13	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	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4876	001	0	1	04	01	H4876_001_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	4	Specialty Tier	4	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				2633.34	33	33	33																				33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	003	0	1	04	01	H4876_003_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	003	0	1	04	01	H4876_003_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4876	003	0	1	04	01	H4876_003_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	003	0	1	04	01	H4876_003_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	003	0	1	04	01	H4876_003_0	4	Specialty Tier	4	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				2150.39	33	33	33																				33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4882	001	0	1	04	01	H4882_001_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												
H4882	001	0	1	04	01	H4882_001_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		24.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	001	0	1	04	01	H4882_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																									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	6	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.55	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	6	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												
H4882	002	0	1	04	01	H4882_002_0	6	Preferred Generic	3	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		16.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	002	0	1	04	01	H4882_002_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												
H4882	002	0	1	04	01	H4882_002_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												
H4882	002	0	1	04	01	H4882_002_0	6	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.75	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	002	0	1	04	01	H4882_002_0	6	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												
H4882	003	0	1	04	01	H4882_003_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		12.00				4.00		8.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	003	0	1	04	01	H4882_003_0	6	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		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	003	0	1	04	01	H4882_003_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												
H4882	003	0	1	04	01	H4882_003_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.82	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	003	0	1	04	01	H4882_003_0	6	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												
H4882	004	0	1	04	01	H4882_004_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												
H4882	004	0	1	04	01	H4882_004_0	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												
H4882	004	0	1	04	01	H4882_004_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		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	004	0	1	04	01	H4882_004_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																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	004	0	1	04	01	H4882_004_0	7	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				281.34	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	8	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												
H4882	005	0	1	04	01	H4882_005_0	8	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		
H4882	005	0	1	04	01	H4882_005_0	8	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												
H4882	005	0	1	04	01	H4882_005_0	8	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		
H4882	005	0	1	04	01	H4882_005_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												
H4882	005	0	1	04	01	H4882_005_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																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	8	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				275.95	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4909	014	0	1	04	01	H4909_014_0	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H4909	014	0	1	04	01	H4909_014_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	8	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		0.00																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	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00		26.00																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	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	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												
H4909	015	0	1	04	01	H4909_015_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4909	016	0	1	04	01	H4909_016_0	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		0.00																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	016	0	1	04	01	H4909_016_0	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00		26.00																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	016	0	1	04	01	H4909_016_0	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	016	0	1	04	01	H4909_016_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	016	0	1	04	01	H4909_016_0	7	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												
H4909	016	0	1	04	01	H4909_016_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4922	008	0	1	01	01	H4922_008_0	9	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												
H4922	008	0	1	01	01	H4922_008_0	9	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		
H4922	008	0	1	01	01	H4922_008_0	9	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																					15.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4922	008	0	1	01	01	H4922_008_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	129.25																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4922	008	0	1	01	01	H4922_008_0	9	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	275.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4922	008	0	1	01	01	H4922_008_0	9	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				100.00	28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4922	011	0	1	01	01	H4922_011_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	7.50																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4922	011	0	1	01	01	H4922_011_0	9	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	7.50																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4922	011	0	1	01	01	H4922_011_0	9	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	30.00																					18.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4922	011	0	1	01	01	H4922_011_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	129.25																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4922	011	0	1	01	01	H4922_011_0	9	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	275.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4922	011	0	1	01	01	H4922_011_0	9	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				100.00	27	27	27																				27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	002	0	1	04	01	H5009_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								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												
H5009	002	0	1	04	01	H5009_002_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	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												
H5009	002	0	1	04	01	H5009_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	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												
H5009	002	0	1	04	01	H5009_002_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1304.10	27						1304.10	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	008	0	1	04	01	H5009_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								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												
H5009	008	0	1	04	01	H5009_008_0	9	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					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												
H5009	008	0	1	04	01	H5009_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								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												
H5009	008	0	1	04	01	H5009_008_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	008	0	1	04	01	H5009_008_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1255.80	26						1255.80	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	002	0	1	04	01	H5010_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								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												
H5010	002	0	1	04	01	H5010_002_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	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												
H5010	002	0	1	04	01	H5010_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	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												
H5010	002	0	1	04	01	H5010_002_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1304.10	27						1304.10	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_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												
H5010	004	0	1	04	01	H5010_004_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												
H5010	004	0	1	04	01	H5010_004_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												
H5010	004	0	1	04	01	H5010_004_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	9	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1593.90	33						1593.90	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5050	004	0	1	01	01	H5050_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	6.00	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_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	6.00	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	004	0	1	01	01	H5050_004_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	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_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	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	004	0	1	01	01	H5050_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	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 Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_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	95.00	190.00	285.00																			95.00	190.00	190.00																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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1402.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	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												
H5050	004	0	1	01	01	H5050_004_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		
H5050	009	0	1	01	01	H5050_009_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	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_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	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	009	0	1	01	01	H5050_009_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	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_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	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	009	0	1	01	01	H5050_009_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	90.00																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	6	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	190.00																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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1445.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	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												
H5050	009	0	1	01	01	H5050_009_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		
H5050	013	0	1	01	01	H5050_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	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_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	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	013	0	1	01	01	H5050_013_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	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_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	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	013	0	1	01	01	H5050_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	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 Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_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	95.00	190.00	285.00																			95.00	190.00	190.00																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	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1138.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	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												
H5050	013	0	1	01	01	H5050_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		
H5050	017	0	1	01	01	H5050_017_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			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_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	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	017	0	1	01	01	H5050_017_0	5	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	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	5	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	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	017	0	1	01	01	H5050_017_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	94.00																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	5	Non-Preferred Brand	4	10	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	194.00																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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				806.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	5	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	5	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		
H5050	019	0	1	01	01	H5050_019_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	6.00																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	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	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	019	0	1	01	01	H5050_019_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	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_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	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	019	0	1	01	01	H5050_019_0	6	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, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_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	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, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1677.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	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												
H5050	019	0	1	01	01	H5050_019_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		
H5050	021	0	1	01	01	H5050_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	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_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	6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	021	0	1	01	01	H5050_021_0	5	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	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	5	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	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	021	0	1	01	01	H5050_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	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 Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_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	190.00																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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				974.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	5	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	5	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		
H5050	022	0	1	01	01	H5050_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	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	5	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																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	022	0	1	01	01	H5050_022_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																			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, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	5	Generic	4	11	1	2	2	3	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, Vaccines										1		
H5050	022	0	1	01	01	H5050_022_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	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_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	190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1324.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	5	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	022	0	1	01	01	H5050_022_0	5	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		
H5087	001	0	1	01	01	H5087_001_0	5	Preferred Generic	4	11	3	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	5	Generic	4	11	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		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	5	Preferred Brand	4	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		86.00				43.00				43.00		1.43				1.43	1.43	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.46	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	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												
H5087	002	0	1	01	01	H5087_002_0	5	Preferred Generic	4	11	3	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	5	Generic	4	11	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		0.00				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	5	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												
H5087	002	0	1	01	01	H5087_002_0	5	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		198.00				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	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												
H5087	005	0	1	01	01	H5087_005_0	4	Preferred Generic	4	11	3	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	11	3	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		3
H5087	005	0	1	01	01	H5087_005_0	4	Generic	4	11	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												
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		94.00				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		198.00				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					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	5	Preferred Generic	4	11	3	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	016	0	1	01	01	H5087_016_0	5	Preferred Generic	4	11	3	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		3
H5087	016	0	1	01	01	H5087_016_0	5	Generic	4	11	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		0.00				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	5	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												
H5087	016	0	1	01	01	H5087_016_0	5	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		198.00				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	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												
H5087	017	0	1	01	01	H5087_017_0	5	Preferred Generic	4	11	3	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	5	Generic	4	11	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		0.00				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	5	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												
H5087	017	0	1	01	01	H5087_017_0	5	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		198.00				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	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												
H5087	023	0	1	01	01	H5087_023_0	6	Preferred Generic	4	11	3	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	023	0	1	01	01	H5087_023_0	6	Preferred Generic	4	11	3	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		3
H5087	023	0	1	01	01	H5087_023_0	6	Generic	4	11	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		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	023	0	1	01	01	H5087_023_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												
H5087	023	0	1	01	01	H5087_023_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																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	023	0	1	01	01	H5087_023_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												
H5106	013	0	1	04	01	H5106_013_0	7	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	7	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	7	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	7	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						280.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1258.86	33						1258.86	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	001	0	1	01	01	H5117_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								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 Drug, Specialty Tier, Select Care Drugs												
H5117	001	0	1	01	01	H5117_001_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	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 Drug, Specialty Tier, Select Care Drugs												
H5117	001	0	1	01	01	H5117_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					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 Drug, Specialty Tier, Select Care Drugs												
H5117	001	0	1	01	01	H5117_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					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 Drug, Specialty Tier, Select Care Drugs												
H5117	001	0	1	01	01	H5117_001_0	8	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, Select Care Drugs												
H5117	001	0	1	01	01	H5117_001_0	8	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 Drug, Specialty Tier, Select Care Drugs												
H5117	002	0	1	01	01	H5117_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								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 Drug, Specialty Tier, Select Care Drugs												
H5117	002	0	1	01	01	H5117_002_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	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 Drug, Specialty Tier, Select Care Drugs												
H5117	002	0	1	01	01	H5117_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	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 Drug, Specialty Tier, Select Care Drugs												
H5117	002	0	1	01	01	H5117_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		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 Drug, Specialty Tier, Select Care Drugs												
H5117	002	0	1	01	01	H5117_002_0	9	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, Select Care Drugs												
H5117	002	0	1	01	01	H5117_002_0	9	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 Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	8	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 Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_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	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 Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_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				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_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					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 Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	8	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, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	8	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 Drug, Specialty Tier, Select Care Drugs												
H5141	001	0	1	04	01	H5141_001_0	18	Preferred Generic	4	11	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	18	Generic	4	11	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	18	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	18	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	18	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1289.81	30	30	30				1289.81	30	30	30						30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	16	Preferred Generic	4	11	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	16	Generic	4	11	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	16	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	16	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	16	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1397.39	30	30	30				1397.39	30	30	30						30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	17	Preferred Generic	4	11	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	17	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											4.75	25	25	25				4.18	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	17	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											49.57	25	25	25				43.62	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	17	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											42.15	25	25	25				42.15	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	17	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											928.88	25	25	25				928.88	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	14	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								8.00	16.00	24.00					3.00	6.00	9.00							6.00																8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	025	0	1	04	01	H5141_025_0	14	Generic	4	11	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	14	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	025	0	1	04	01	H5141_025_0	14	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							180.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	025	0	1	04	01	H5141_025_0	14	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1537.13	33	33	33				1537.13	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	026	0	1	04	01	H5141_026_0	15	Preferred Generic	4	11	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	15	Generic	4	11	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	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	026	0	1	04	01	H5141_026_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							180.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	026	0	1	04	01	H5141_026_0	15	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1537.13	33	33	33				1537.13	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	032	0	1	04	01	H5141_032_0	18	Preferred Generic	4	11	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	18	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								13.00	26.00	39.00					8.00	16.00	24.00							16.00																13.00				13.00			0.43	0.27				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	032	0	1	04	01	H5141_032_0	18	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	032	0	1	04	01	H5141_032_0	18	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	18	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1537.13	33	33	33				1537.13	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	11	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	14.00	21.00					2.00	4.00	6.00							4.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	11	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								17.00	34.00	51.00					12.00	24.00	36.00							24.00																17.00				17.00			0.57	0.40				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	11	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							180.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	11	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1443.97	31	31	31				1443.97	31	31	31						31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	36.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	15	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											4.75	25	25	25				4.18	22	22	22						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	15	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											49.57	25	25	25				43.62	22	22	22						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	15	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											42.15	25	25	25				42.15	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	15	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											928.88	25	25	25				928.88	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	14	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	36.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	14	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											4.75	25	25	25				4.18	22	22	22						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	14	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											49.57	25	25	25				43.62	22	22	22						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	14	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											42.15	25	25	25				42.15	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	14	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											928.88	25	25	25				928.88	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	036	0	1	04	01	H5141_036_0	14	Preferred Generic	4	11	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	036	0	1	04	01	H5141_036_0	14	Generic	4	11	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	036	0	1	04	01	H5141_036_0	14	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	036	0	1	04	01	H5141_036_0	14	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							180.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	036	0	1	04	01	H5141_036_0	14	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1537.13	33	33	33				1537.13	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	13	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	36.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	13	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											4.75	25	25	25				4.18	22	22	22						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	13	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											49.57	25	25	25				43.62	22	22	22						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											42.15	25	25	25				42.15	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	13	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											928.88	25	25	25				928.88	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	13	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	14.00	21.00					2.00	4.00	6.00							4.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	13	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								17.00	34.00	51.00					12.00	24.00	36.00							24.00																17.00				17.00			0.57	0.40				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	13	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	13	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							180.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	13	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1537.13	33	33	33				1537.13	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	039	0	1	04	01	H5141_039_0	15	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	36.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	039	0	1	04	01	H5141_039_0	15	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											4.75	25	25	25				4.18	22	22	22						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	039	0	1	04	01	H5141_039_0	15	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											49.57	25	25	25				43.62	22	22	22						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	039	0	1	04	01	H5141_039_0	15	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											42.15	25	25	25				42.15	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	039	0	1	04	01	H5141_039_0	15	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											928.88	25	25	25				928.88	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	040	0	1	04	01	H5141_040_0	16	Preferred Generic	4	11	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	040	0	1	04	01	H5141_040_0	16	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	36.00					7.00	14.00	21.00							14.00																12.00				12.00			0.40	0.23				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	040	0	1	04	01	H5141_040_0	16	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	040	0	1	04	01	H5141_040_0	16	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							180.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	040	0	1	04	01	H5141_040_0	16	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1537.13	33	33	33				1537.13	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	041	0	1	04	01	H5141_041_0	15	Preferred Generic	4	11	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	041	0	1	04	01	H5141_041_0	15	Generic	4	11	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	041	0	1	04	01	H5141_041_0	15	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	041	0	1	04	01	H5141_041_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					90.00	180.00	270.00							180.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	041	0	1	04	01	H5141_041_0	15	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1537.13	33	33	33				1537.13	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	042	0	1	04	01	H5141_042_0	13	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	36.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	042	0	1	04	01	H5141_042_0	13	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											4.75	25	25	25				4.18	22	22	22						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	042	0	1	04	01	H5141_042_0	13	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											49.57	25	25	25				43.62	22	22	22						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	042	0	1	04	01	H5141_042_0	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											42.15	25	25	25				42.15	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	042	0	1	04	01	H5141_042_0	13	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											928.88	25	25	25				928.88	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5172	002	0	1	48	05	H5172_002_0	3	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	3	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	8.50	0.00	8.50	0.00	8.50	0.00	8.50			
H5172	002	0	1	48	05	H5172_002_0	3	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	3	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	6	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	6	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	6	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	6	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	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 Drug, Specialty Tier, Select Care Drugs												
H5190	001	0	1	01	01	H5190_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, Select Care Drugs												
H5190	001	0	1	01	01	H5190_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 Drug, Specialty Tier, Select Care Drugs												
H5190	001	0	1	01	01	H5190_001_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5190	001	0	1	01	01	H5190_001_0	6	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	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, Select Care Drugs												
H5190	002	0	1	01	01	H5190_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, Select Care Drugs										1		
H5190	002	0	1	01	01	H5190_002_0	5	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	5	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	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 Drug, Specialty Tier, Select Care Drugs												
H5190	002	0	1	01	01	H5190_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	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	5	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	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 Drug, Specialty Tier, Select Care Drugs												
H5190	002	0	1	01	01	H5190_002_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5190	003	0	1	01	01	H5190_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	0.00	0.00	0.00																			0.00	0.00	0.00																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	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, Select Care Drugs										1		
H5190	003	0	1	01	01	H5190_003_0	5	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	5	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	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 Drug, Specialty Tier, Select Care Drugs												
H5190	003	0	1	01	01	H5190_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	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	5	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	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 Drug, Specialty Tier, Select Care Drugs												
H5190	003	0	1	01	01	H5190_003_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5190	004	0	1	01	01	H5190_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	0.00	0.00	0.00																			0.00	0.00	0.00																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	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, Select Care Drugs										1		
H5190	004	0	1	01	01	H5190_004_0	5	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	5	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	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 Drug, Specialty Tier, Select Care Drugs												
H5190	004	0	1	01	01	H5190_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		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	5	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	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 Drug, Specialty Tier, Select Care Drugs												
H5190	004	0	1	01	01	H5190_004_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5199	001	0	1	04	01	H5199_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	001	0	1	04	01	H5199_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5199	001	0	1	04	01	H5199_001_0	4	Generic	4	11	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		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	001	0	1	04	01	H5199_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		94.00				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	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		200.00				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	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 Drug, Specialty Tier												
H5199	002	0	1	04	01	H5199_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	002	0	1	04	01	H5199_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5199	002	0	1	04	01	H5199_002_0	4	Generic	4	11	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		0.00				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		94.00				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		200.00				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					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	003	0	1	04	01	H5199_003_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	003	0	1	04	01	H5199_003_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5199	003	0	1	04	01	H5199_003_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	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		94.00				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		200.00				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					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	004	0	1	04	01	H5199_004_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	004	0	1	04	01	H5199_004_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5199	004	0	1	04	01	H5199_004_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	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		94.00				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		200.00				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					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	005	0	1	04	01	H5199_005_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	005	0	1	04	01	H5199_005_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5199	005	0	1	04	01	H5199_005_0	4	Generic	4	11	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												
H5199	005	0	1	04	01	H5199_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	005	0	1	04	01	H5199_005_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		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	005	0	1	04	01	H5199_005_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 Drug, Specialty Tier												
H5199	006	0	1	04	01	H5199_006_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	006	0	1	04	01	H5199_006_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5199	006	0	1	04	01	H5199_006_0	4	Generic	4	11	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		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	006	0	1	04	01	H5199_006_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	006	0	1	04	01	H5199_006_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		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	006	0	1	04	01	H5199_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												
H5199	007	0	1	04	01	H5199_007_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	007	0	1	04	01	H5199_007_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5199	007	0	1	04	01	H5199_007_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	007	0	1	04	01	H5199_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	007	0	1	04	01	H5199_007_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		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	007	0	1	04	01	H5199_007_0	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 Drug, Specialty Tier												
H5199	008	0	1	04	01	H5199_008_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	008	0	1	04	01	H5199_008_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5199	008	0	1	04	01	H5199_008_0	4	Generic	4	11	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		0.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	008	0	1	04	01	H5199_008_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	008	0	1	04	01	H5199_008_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		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	008	0	1	04	01	H5199_008_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 Drug, Specialty Tier												
H5199	009	0	1	04	01	H5199_009_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	009	0	1	04	01	H5199_009_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5199	009	0	1	04	01	H5199_009_0	4	Generic	4	11	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												
H5199	009	0	1	04	01	H5199_009_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	009	0	1	04	01	H5199_009_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		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	009	0	1	04	01	H5199_009_0	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 Drug, Specialty Tier												
H5199	010	0	1	04	01	H5199_010_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	010	0	1	04	01	H5199_010_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5199	010	0	1	04	01	H5199_010_0	4	Generic	4	11	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		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	010	0	1	04	01	H5199_010_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	010	0	1	04	01	H5199_010_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		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	010	0	1	04	01	H5199_010_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												
H5199	011	0	1	04	01	H5199_011_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	011	0	1	04	01	H5199_011_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5199	011	0	1	04	01	H5199_011_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	011	0	1	04	01	H5199_011_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	011	0	1	04	01	H5199_011_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		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	011	0	1	04	01	H5199_011_0	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 Drug, Specialty Tier												
H5199	012	0	1	04	01	H5199_012_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	012	0	1	04	01	H5199_012_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5199	012	0	1	04	01	H5199_012_0	4	Generic	4	11	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												
H5199	012	0	1	04	01	H5199_012_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	012	0	1	04	01	H5199_012_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		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	012	0	1	04	01	H5199_012_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 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	31	62	93				1	2	31	62	93				31		34	7.00	14.00	21.00																			7.00	14.00	21.00																7.00				7.00		0.23			0.23			0.21	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	31	62	93				1	2	31	62	93				31		34	16.00	32.00	48.00																			16.00	32.00	48.00																16.00				16.00		0.52			0.52			0.47	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	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	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	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			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	31								31						31		34				2061.00	26																				26																	26			26								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	31														31		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	7	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	9.00	18.00	27.00																			9.00	18.00	27.00																9.00				9.00		0.29			0.29			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	7	Generic	4	01	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	7	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				2537.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	7	Vaccines	4	11	1	2	6	1	010		01			1	31														31		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	31	62	93				1	2	31	62	93				31		34	7.00	14.00	21.00																			7.00	14.00	21.00																7.00				7.00		0.23			0.23			0.21	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	31	62	93				1	2	31	62	93				31		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.59	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	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	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	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			2.94	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	31								31						31		34				1831.00	26																				26																	26			26								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	31														31		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	6	Preferred Generic	3	01	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.26			0.26			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	6	Generic	3	01	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	6	Preferred Brand	3	11	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	6	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	6	Specialty Tier	3	11	1	1	5	1	010		01	010		1	31								31						31		34				2061.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	6	Vaccines	3	11	1	2	6	1	010		01			1	31														31		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	6	Preferred Generic	3	01	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	7.00	14.00	21.00																			7.00	14.00	21.00																7.00				7.00		0.23			0.23			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	6	Generic	3	01	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	6	Preferred Brand	3	11	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	6	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	6	Specialty Tier	3	11	1	1	5	1	010		01	010		1	31								31						31		34				2219.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	6	Vaccines	3	11	1	2	6	1	010		01			1	31														31		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	6	Preferred Generic	3	01	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.26			0.26			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	6	Generic	3	01	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	6	Preferred Brand	3	11	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	6	Non-Preferred Drug	3	11	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	6	Specialty Tier	3	11	1	1	5	1	010		01	010		1	31								31						31		34				2061.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	6	Vaccines	3	11	1	2	6	1	010		01			1	31														31		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	10	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		0.00																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	10	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	10	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	10	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	10	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												
H5215	005	0	1	04	01	H5215_005_0	9	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		0.00																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	9	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	9	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	9	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	9	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												
H5215	007	0	1	04	01	H5215_007_0	10	Preferred Generic	3	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		15.00					4.00		10.00					4.00		0.00																4.00				4.00			0.20	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	10	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	10	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	10	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	10	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 Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	9	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		0.00																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	9	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	9	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	9	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	9	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	9	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		0.00																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	9	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	9	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	9	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	9	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	9	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		0.00																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	9	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	9	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	9	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	9	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												
H5215	011	0	1	04	01	H5215_011_0	9	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		0.00																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	9	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	9	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	9	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	9	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												
H5216	001	0	1	04	01	H5216_001_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												
H5216	001	0	1	04	01	H5216_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	5	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	006	0	1	04	01	H5216_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												
H5216	006	0	1	04	01	H5216_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_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												
H5216	009	0	1	04	01	H5216_009_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												
H5216	009	0	1	04	01	H5216_009_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_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												
H5216	011	0	1	04	01	H5216_011_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												
H5216	011	0	1	04	01	H5216_011_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_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												
H5216	013	0	1	04	01	H5216_013_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												
H5216	013	0	1	04	01	H5216_013_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	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 Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_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												
H5216	014	0	1	04	01	H5216_014_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	5	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				83.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	5	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	015	1	1	04	01	H5216_015_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					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	015	1	1	04	01	H5216_015_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	015	1	1	04	01	H5216_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	015	1	1	04	01	H5216_015_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	015	1	1	04	01	H5216_015_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												
H5216	015	2	1	04	01	H5216_015_2	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	015	2	1	04	01	H5216_015_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	015	2	1	04	01	H5216_015_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	015	2	1	04	01	H5216_015_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	015	2	1	04	01	H5216_015_2	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	017	0	1	04	01	H5216_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_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	018	0	1	04	01	H5216_018_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	018	0	1	04	01	H5216_018_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	018	0	1	04	01	H5216_018_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	018	0	1	04	01	H5216_018_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	018	0	1	04	01	H5216_018_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												
H5216	019	0	1	04	01	H5216_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					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	019	0	1	04	01	H5216_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_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												
H5216	020	0	1	04	01	H5216_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					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	020	0	1	04	01	H5216_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	020	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	020	0	1	04	01	H5216_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	020	0	1	04	01	H5216_020_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	021	0	1	04	01	H5216_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					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	021	0	1	04	01	H5216_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_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												
H5216	022	0	1	04	01	H5216_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					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	022	0	1	04	01	H5216_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	022	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	022	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	022	0	1	04	01	H5216_022_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	023	0	1	04	01	H5216_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												
H5216	023	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_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	024	0	1	04	01	H5216_024_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	024	0	1	04	01	H5216_024_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_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	025	0	1	04	01	H5216_025_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	025	0	1	04	01	H5216_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	025	0	1	04	01	H5216_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	025	0	1	04	01	H5216_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	025	0	1	04	01	H5216_025_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	026	0	1	04	01	H5216_026_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	026	0	1	04	01	H5216_026_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	026	0	1	04	01	H5216_026_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	026	0	1	04	01	H5216_026_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	026	0	1	04	01	H5216_026_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	027	0	1	04	01	H5216_027_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	027	0	1	04	01	H5216_027_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_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	028	0	1	04	01	H5216_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					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	028	0	1	04	01	H5216_028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	028	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	028	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	028	0	1	04	01	H5216_028_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	029	0	1	04	01	H5216_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					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	029	0	1	04	01	H5216_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_029_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	032	0	1	04	01	H5216_032_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												
H5216	032	0	1	04	01	H5216_032_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_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	033	1	1	04	01	H5216_033_1	3	Preferred Generic	4	11	3	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	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	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	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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	2	1	04	01	H5216_033_2	3	Preferred Generic	4	11	3	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	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	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	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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	6	1	04	01	H5216_033_6	3	Preferred Generic	4	11	3	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	6	1	04	01	H5216_033_6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	6	1	04	01	H5216_033_6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	6	1	04	01	H5216_033_6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	6	1	04	01	H5216_033_6	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												
H5216	034	0	1	04	01	H5216_034_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	034	0	1	04	01	H5216_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_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												
H5216	035	0	1	04	01	H5216_035_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	035	0	1	04	01	H5216_035_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	035	0	1	04	01	H5216_035_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	035	0	1	04	01	H5216_035_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	035	0	1	04	01	H5216_035_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	036	0	1	04	01	H5216_036_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_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	037	0	1	04	01	H5216_037_0	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_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	039	0	1	04	01	H5216_039_0	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_039_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												
H5216	040	0	1	04	01	H5216_040_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												
H5216	040	0	1	04	01	H5216_040_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	040	0	1	04	01	H5216_040_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	040	0	1	04	01	H5216_040_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	040	0	1	04	01	H5216_040_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	041	0	1	04	01	H5216_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					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	041	0	1	04	01	H5216_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	041	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	041	0	1	04	01	H5216_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	041	0	1	04	01	H5216_041_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	042	0	1	04	01	H5216_042_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	042	0	1	04	01	H5216_042_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_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	043	1	1	04	01	H5216_043_1	4	Preferred Generic	4	11	3	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												
H5216	043	1	1	04	01	H5216_043_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	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												
H5216	043	2	1	04	01	H5216_043_2	5	Preferred Generic	4	11	3	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												
H5216	043	2	1	04	01	H5216_043_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	2	1	04	01	H5216_043_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	2	1	04	01	H5216_043_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	2	1	04	01	H5216_043_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 Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	5	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_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	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	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	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	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												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	4	Preferred Generic	4	11	3	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	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	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	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	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	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	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												25							25												25						25					25			25								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	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	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	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												31							31												31						31					31			31								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	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	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	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	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	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	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	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	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	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	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	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	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	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	054	0	1	04	01	H5216_054_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_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	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	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	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	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	057	0	1	04	01	H5216_057_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												
H5216	057	0	1	04	01	H5216_057_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	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 Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_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												
H5216	058	0	1	04	01	H5216_058_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_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												
H5216	060	0	1	04	01	H5216_060_0	5	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	060	0	1	04	01	H5216_060_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	060	0	1	04	01	H5216_060_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	060	0	1	04	01	H5216_060_0	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 Drug, Specialty Tier												
H5216	061	0	1	04	01	H5216_061_0	5	Preferred Generic	4	11	3	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	061	0	1	04	01	H5216_061_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	061	0	1	04	01	H5216_061_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	061	0	1	04	01	H5216_061_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	061	0	1	04	01	H5216_061_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												
H5216	062	0	1	04	01	H5216_062_0	5	Preferred Generic	4	11	3	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_0	5	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	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												
H5216	063	0	1	04	01	H5216_063_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	063	0	1	04	01	H5216_063_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	063	0	1	04	01	H5216_063_0	5	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				64.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	063	0	1	04	01	H5216_063_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												
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	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	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	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	5	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	065	0	1	04	01	H5216_065_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	065	0	1	04	01	H5216_065_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	065	0	1	04	01	H5216_065_0	5	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	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	066	0	1	04	01	H5216_066_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	066	0	1	04	01	H5216_066_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	066	0	1	04	01	H5216_066_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	066	0	1	04	01	H5216_066_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	067	0	1	04	01	H5216_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	067	0	1	04	01	H5216_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	067	0	1	04	01	H5216_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	067	0	1	04	01	H5216_067_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	068	0	1	04	01	H5216_068_0	5	Preferred Generic	4	11	3	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	068	0	1	04	01	H5216_068_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	068	0	1	04	01	H5216_068_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	068	0	1	04	01	H5216_068_0	5	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	5	Preferred Generic	4	11	3	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	070	0	1	04	01	H5216_070_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_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	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	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	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	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												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	5	Preferred Generic	4	11	3	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	072	0	1	04	01	H5216_072_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	5	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	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	073	0	1	04	01	H5216_073_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_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	074	0	1	04	01	H5216_074_0	5	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_0	5	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	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	075	0	1	04	01	H5216_075_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_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	076	0	1	04	01	H5216_076_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	076	0	1	04	01	H5216_076_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	076	0	1	04	01	H5216_076_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	076	0	1	04	01	H5216_076_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	076	0	1	04	01	H5216_076_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	078	1	1	04	01	H5216_078_1	5	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	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	078	2	1	04	01	H5216_078_2	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	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	080	1	1	04	01	H5216_080_1	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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	50		50				89.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	5	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	080	2	1	04	01	H5216_080_2	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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	2	1	04	01	H5216_080_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	2	1	04	01	H5216_080_2	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	50		50				89.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	2	1	04	01	H5216_080_2	5	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	080	3	1	04	01	H5216_080_3	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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	50		50				89.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	5	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	081	0	1	04	01	H5216_081_0	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_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	083	0	1	04	01	H5216_083_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												
H5216	083	0	1	04	01	H5216_083_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_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	085	0	1	04	01	H5216_085_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												
H5216	085	0	1	04	01	H5216_085_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	085	0	1	04	01	H5216_085_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	085	0	1	04	01	H5216_085_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	45		45				92.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	085	0	1	04	01	H5216_085_0	5	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	088	0	1	04	01	H5216_088_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	088	0	1	04	01	H5216_088_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											84.00	50		50				86.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	5	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	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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	5	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				61.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	5	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	091	0	1	04	01	H5216_091_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												
H5216	091	0	1	04	01	H5216_091_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	091	0	1	04	01	H5216_091_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	091	0	1	04	01	H5216_091_0	5	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				84.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	091	0	1	04	01	H5216_091_0	5	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	092	0	1	04	01	H5216_092_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											90.00	50		50				90.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	5	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	093	0	1	04	01	H5216_093_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	093	0	1	04	01	H5216_093_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_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	094	0	1	04	01	H5216_094_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	094	0	1	04	01	H5216_094_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	094	0	1	04	01	H5216_094_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	094	0	1	04	01	H5216_094_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	094	0	1	04	01	H5216_094_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												
H5216	095	0	1	04	01	H5216_095_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	095	0	1	04	01	H5216_095_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	095	0	1	04	01	H5216_095_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	095	0	1	04	01	H5216_095_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	095	0	1	04	01	H5216_095_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	096	0	1	04	01	H5216_096_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	096	0	1	04	01	H5216_096_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_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	097	0	1	04	01	H5216_097_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	097	0	1	04	01	H5216_097_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_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	098	0	1	04	01	H5216_098_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	098	0	1	04	01	H5216_098_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_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	099	0	1	04	01	H5216_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_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	100	0	1	04	01	H5216_100_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	100	0	1	04	01	H5216_100_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_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												
H5216	103	0	1	04	01	H5216_103_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												
H5216	103	0	1	04	01	H5216_103_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_0	5	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				75.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_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												
H5216	104	0	1	04	01	H5216_104_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												
H5216	104	0	1	04	01	H5216_104_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	104	0	1	04	01	H5216_104_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	104	0	1	04	01	H5216_104_0	5	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				77.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	104	0	1	04	01	H5216_104_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												
H5216	106	0	1	04	01	H5216_106_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	106	0	1	04	01	H5216_106_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_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	107	0	1	04	01	H5216_107_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	107	0	1	04	01	H5216_107_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_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	108	0	1	04	01	H5216_108_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	108	0	1	04	01	H5216_108_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	108	0	1	04	01	H5216_108_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	108	0	1	04	01	H5216_108_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	108	0	1	04	01	H5216_108_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	109	0	1	04	01	H5216_109_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	109	0	1	04	01	H5216_109_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_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	110	0	1	04	01	H5216_110_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	110	0	1	04	01	H5216_110_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	110	0	1	04	01	H5216_110_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	110	0	1	04	01	H5216_110_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	110	0	1	04	01	H5216_110_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	111	0	1	04	01	H5216_111_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	111	0	1	04	01	H5216_111_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_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	112	0	1	04	01	H5216_112_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	112	0	1	04	01	H5216_112_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_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	113	0	1	04	01	H5216_113_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	113	0	1	04	01	H5216_113_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	113	0	1	04	01	H5216_113_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	113	0	1	04	01	H5216_113_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	113	0	1	04	01	H5216_113_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	114	0	1	04	01	H5216_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_114_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	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	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	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	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												25							25												25						25					25			25								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								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	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					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	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	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	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												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	119	0	1	04	01	H5216_119_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	119	0	1	04	01	H5216_119_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	119	0	1	04	01	H5216_119_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	119	0	1	04	01	H5216_119_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	119	0	1	04	01	H5216_119_0	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 Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_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	120	0	1	04	01	H5216_120_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	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 Drug, Specialty Tier												
H5216	121	0	1	04	01	H5216_121_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	121	0	1	04	01	H5216_121_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	121	0	1	04	01	H5216_121_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	121	0	1	04	01	H5216_121_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	121	0	1	04	01	H5216_121_0	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 Drug, Specialty Tier												
H5216	122	0	1	04	01	H5216_122_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	122	0	1	04	01	H5216_122_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	122	0	1	04	01	H5216_122_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	122	0	1	04	01	H5216_122_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	122	0	1	04	01	H5216_122_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	124	0	1	04	01	H5216_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	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 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	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	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	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												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	131	0	1	04	01	H5216_131_0	4	Preferred Generic	4	11	3	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	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	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	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	3	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	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	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	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	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												
H5216	133	0	1	04	01	H5216_133_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_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												
H5216	135	0	1	04	01	H5216_135_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	135	0	1	04	01	H5216_135_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	135	0	1	04	01	H5216_135_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	135	0	1	04	01	H5216_135_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	135	0	1	04	01	H5216_135_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	136	0	1	04	01	H5216_136_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	136	0	1	04	01	H5216_136_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_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	137	0	1	04	01	H5216_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_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												
H5216	138	0	1	04	01	H5216_138_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	138	0	1	04	01	H5216_138_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_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	139	0	1	04	01	H5216_139_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												
H5216	139	0	1	04	01	H5216_139_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	139	0	1	04	01	H5216_139_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	139	0	1	04	01	H5216_139_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	139	0	1	04	01	H5216_139_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	141	0	1	04	01	H5216_141_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	141	0	1	04	01	H5216_141_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_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												
H5216	142	1	1	04	01	H5216_142_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					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	142	1	1	04	01	H5216_142_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	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	142	2	1	04	01	H5216_142_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					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	142	2	1	04	01	H5216_142_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	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	143	0	1	04	01	H5216_143_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	143	0	1	04	01	H5216_143_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	143	0	1	04	01	H5216_143_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	143	0	1	04	01	H5216_143_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	143	0	1	04	01	H5216_143_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												
H5216	144	0	1	04	01	H5216_144_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	144	0	1	04	01	H5216_144_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_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	145	0	1	04	01	H5216_145_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	145	0	1	04	01	H5216_145_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	145	0	1	04	01	H5216_145_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	145	0	1	04	01	H5216_145_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	145	0	1	04	01	H5216_145_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	146	0	1	04	01	H5216_146_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	146	0	1	04	01	H5216_146_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	146	0	1	04	01	H5216_146_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	146	0	1	04	01	H5216_146_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	146	0	1	04	01	H5216_146_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	147	0	1	04	01	H5216_147_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	147	0	1	04	01	H5216_147_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	147	0	1	04	01	H5216_147_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	147	0	1	04	01	H5216_147_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	147	0	1	04	01	H5216_147_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	148	0	1	04	01	H5216_148_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	148	0	1	04	01	H5216_148_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	148	0	1	04	01	H5216_148_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	148	0	1	04	01	H5216_148_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	148	0	1	04	01	H5216_148_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	149	0	1	04	01	H5216_149_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												
H5216	149	0	1	04	01	H5216_149_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_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												
H5216	150	0	1	04	01	H5216_150_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	150	0	1	04	01	H5216_150_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	150	0	1	04	01	H5216_150_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	150	0	1	04	01	H5216_150_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	150	0	1	04	01	H5216_150_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	151	0	1	04	01	H5216_151_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	151	0	1	04	01	H5216_151_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	151	0	1	04	01	H5216_151_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	151	0	1	04	01	H5216_151_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	151	0	1	04	01	H5216_151_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	153	0	1	04	01	H5216_153_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	153	0	1	04	01	H5216_153_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	153	0	1	04	01	H5216_153_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	153	0	1	04	01	H5216_153_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	153	0	1	04	01	H5216_153_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												
H5216	154	0	1	04	01	H5216_154_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	154	0	1	04	01	H5216_154_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_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	155	0	1	04	01	H5216_155_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	155	0	1	04	01	H5216_155_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	155	0	1	04	01	H5216_155_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	155	0	1	04	01	H5216_155_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	155	0	1	04	01	H5216_155_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	156	0	1	04	01	H5216_156_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	156	0	1	04	01	H5216_156_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	156	0	1	04	01	H5216_156_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	156	0	1	04	01	H5216_156_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	156	0	1	04	01	H5216_156_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	158	0	1	04	01	H5216_158_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					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	158	0	1	04	01	H5216_158_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_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	159	0	1	04	01	H5216_159_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												
H5216	159	0	1	04	01	H5216_159_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	159	0	1	04	01	H5216_159_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	159	0	1	04	01	H5216_159_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	159	0	1	04	01	H5216_159_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	160	0	1	04	01	H5216_160_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												
H5216	160	0	1	04	01	H5216_160_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					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_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												
H5216	161	0	1	04	01	H5216_161_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												
H5216	161	0	1	04	01	H5216_161_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_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												
H5216	163	0	1	04	01	H5216_163_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												
H5216	163	0	1	04	01	H5216_163_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	163	0	1	04	01	H5216_163_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	163	0	1	04	01	H5216_163_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	163	0	1	04	01	H5216_163_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	164	0	1	04	01	H5216_164_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	164	0	1	04	01	H5216_164_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	164	0	1	04	01	H5216_164_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	164	0	1	04	01	H5216_164_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	164	0	1	04	01	H5216_164_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												
H5216	165	0	1	04	01	H5216_165_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	165	0	1	04	01	H5216_165_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					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	165	0	1	04	01	H5216_165_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	165	0	1	04	01	H5216_165_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	165	0	1	04	01	H5216_165_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	166	0	1	04	01	H5216_166_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	166	0	1	04	01	H5216_166_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	166	0	1	04	01	H5216_166_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	166	0	1	04	01	H5216_166_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	166	0	1	04	01	H5216_166_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	167	0	1	04	01	H5216_167_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												
H5216	167	0	1	04	01	H5216_167_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											84.00	50		50				82.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	5	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	168	0	1	04	01	H5216_168_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												
H5216	168	0	1	04	01	H5216_168_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											79.00	50		50				77.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_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												
H5216	169	0	1	04	01	H5216_169_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	169	0	1	04	01	H5216_169_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_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												
H5216	170	0	1	04	01	H5216_170_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	170	0	1	04	01	H5216_170_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_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	171	0	1	04	01	H5216_171_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												
H5216	171	0	1	04	01	H5216_171_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_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												
H5216	172	0	1	04	01	H5216_172_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												
H5216	172	0	1	04	01	H5216_172_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_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												
H5216	173	0	1	04	01	H5216_173_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												
H5216	173	0	1	04	01	H5216_173_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_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												
H5216	175	0	1	04	01	H5216_175_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												
H5216	175	0	1	04	01	H5216_175_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_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												
H5216	176	0	1	04	01	H5216_176_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												
H5216	176	0	1	04	01	H5216_176_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_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												
H5216	177	0	1	04	01	H5216_177_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												
H5216	177	0	1	04	01	H5216_177_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_0	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 Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_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	179	0	1	04	01	H5216_179_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_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	180	0	1	04	01	H5216_180_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	180	0	1	04	01	H5216_180_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_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	181	0	1	04	01	H5216_181_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	181	0	1	04	01	H5216_181_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	181	0	1	04	01	H5216_181_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	181	0	1	04	01	H5216_181_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	181	0	1	04	01	H5216_181_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	182	0	1	04	01	H5216_182_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	182	0	1	04	01	H5216_182_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_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	184	0	1	04	01	H5216_184_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	184	0	1	04	01	H5216_184_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	184	0	1	04	01	H5216_184_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	184	0	1	04	01	H5216_184_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	184	0	1	04	01	H5216_184_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												
H5216	185	0	1	04	01	H5216_185_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	185	0	1	04	01	H5216_185_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_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												
H5216	186	0	1	04	01	H5216_186_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												
H5216	186	0	1	04	01	H5216_186_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_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												
H5216	187	0	1	04	01	H5216_187_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												
H5216	187	0	1	04	01	H5216_187_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	187	0	1	04	01	H5216_187_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	187	0	1	04	01	H5216_187_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	187	0	1	04	01	H5216_187_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	188	0	1	04	01	H5216_188_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	188	0	1	04	01	H5216_188_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_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	189	0	1	04	01	H5216_189_0	4	Preferred Generic	4	11	3	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	189	0	1	04	01	H5216_189_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_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	192	0	1	04	01	H5216_192_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	192	0	1	04	01	H5216_192_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_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	193	0	1	04	01	H5216_193_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												
H5216	193	0	1	04	01	H5216_193_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_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	194	0	1	04	01	H5216_194_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	194	0	1	04	01	H5216_194_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_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												
H5216	195	0	1	04	01	H5216_195_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												
H5216	195	0	1	04	01	H5216_195_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_0	5	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	50		50				74.00	40		40										50		50				40		40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_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												
H5216	196	1	1	04	01	H5216_196_1	4	Preferred Generic	4	11	3	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	196	1	1	04	01	H5216_196_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_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												
H5216	196	2	1	04	01	H5216_196_2	4	Preferred Generic	4	11	3	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	196	2	1	04	01	H5216_196_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	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	197	0	1	04	01	H5216_197_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					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												
H5216	197	0	1	04	01	H5216_197_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	5	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											102.00	50		50				102.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_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												
H5216	198	0	1	04	01	H5216_198_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	198	0	1	04	01	H5216_198_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_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	199	0	1	04	01	H5216_199_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					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												
H5216	199	0	1	04	01	H5216_199_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_0	5	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											103.00	50		50				103.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_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												
H5253	004	0	1	01	01	H5253_004_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	004	0	1	01	01	H5253_004_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1058.00	28		28																										28						28			28			28								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				2	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				2	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				2	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				2	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				2	2						90	30		31				936.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1067.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1034.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				708.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				863.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				816.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5253	037	0	1	01	01	H5253_037_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1136.00	32		32																										32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	01	01	H5253_038_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1080.00	31		31																										31						31			31			31								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				2	2						90	30		31	2.00		4.00																											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				2	2						90	30		31	8.00		16.00																											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				2	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				2	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				2	2						90	30		31				1022.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				890.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				854.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				853.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	046	0	1	01	01	H5253_046_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1118.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	02	01	H5253_047_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				897.00	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	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	02	01	H5253_048_0	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				939.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				799.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	050	0	1	01	01	H5253_050_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	050	0	1	01	01	H5253_050_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				811.00	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	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	051	0	1	01	01	H5253_051_0	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	2	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	051	0	1	01	01	H5253_051_0	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				701.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				927.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	053	0	1	01	01	H5253_053_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	053	0	1	01	01	H5253_053_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				807.00	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	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	054	0	1	01	01	H5253_054_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	054	0	1	01	01	H5253_054_0	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	2	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	054	0	1	01	01	H5253_054_0	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				877.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	056	0	1	01	01	H5253_056_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	056	0	1	01	01	H5253_056_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1133.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				648.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				822.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				813.00	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	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	063	0	1	01	01	H5253_063_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	063	0	1	01	01	H5253_063_0	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	2	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	063	0	1	01	01	H5253_063_0	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				819.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1076.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	3	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	067	0	1	01	01	H5253_067_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	3	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	067	0	1	01	01	H5253_067_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				738.00	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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	2	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	068	0	1	01	01	H5253_068_0	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	2	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	068	0	1	01	01	H5253_068_0	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				801.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				614.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	01	01	H5253_073_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				878.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1023.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	075	0	1	01	01	H5253_075_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	075	0	1	01	01	H5253_075_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				880.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	076	0	1	01	01	H5253_076_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				994.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	077	0	1	01	01	H5253_077_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1246.00	31		31																										31						31			31			31								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				2	2						90	30		31	2.00		4.00																											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				2	2						90	30		31	8.00		16.00																											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				2	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				2	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				2	2						90	30		31				1100.00	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	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	5	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	5	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	080	0	1	01	01	H5253_080_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1038.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				926.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				991.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				620.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											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	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				769.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H5253	085	0	1	01	01	H5253_085_0	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				976.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	086	0	1	01	01	H5253_086_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	4	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H5253	086	0	1	01	01	H5253_086_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				953.00	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				2	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	3	2	2	1	110		01		100	1	30		90				2	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	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H5253	087	0	1	01	01	H5253_087_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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				2	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				2	2						90	30		31				910.00	31		31																										31						31			31			31								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				2	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	3	2	2	1	110		01		100	1	30		90				2	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	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H5253	088	0	1	01	01	H5253_088_0	4	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						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				2	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				2	2						90	30		31				1054.00	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				2	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	3	2	2	1	110		01		100	1	30		90				2	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	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H5253	089	0	1	01	01	H5253_089_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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				2	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				2	2						90	30		31				820.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	090	0	1	01	01	H5253_090_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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	3	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										2		2
H5253	090	0	1	01	01	H5253_090_0	3	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1082.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				871.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1065.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	01	01	H5253_099_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	099	0	1	01	01	H5253_099_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	099	0	1	01	01	H5253_099_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	01	01	H5253_099_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	099	0	1	01	01	H5253_099_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				871.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	01	01	H5253_100_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	01	01	H5253_100_0	4	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	100	0	1	01	01	H5253_100_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	01	01	H5253_100_0	4	Generic	4	01	1	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	100	0	1	01	01	H5253_100_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	100	0	1	01	01	H5253_100_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	100	0	1	01	01	H5253_100_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				785.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	01	01	H5253_102_0	7	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	01	01	H5253_102_0	7	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	01	01	H5253_102_0	7	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	102	0	1	01	01	H5253_102_0	7	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	102	0	1	01	01	H5253_102_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	102	0	1	01	01	H5253_102_0	7	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				813.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	01	01	H5253_103_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	01	01	H5253_103_0	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	01	01	H5253_103_0	5	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	103	0	1	01	01	H5253_103_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	103	0	1	01	01	H5253_103_0	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1030.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	01	01	H5253_104_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	01	01	H5253_104_0	6	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	01	01	H5253_104_0	6	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	104	0	1	01	01	H5253_104_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	104	0	1	01	01	H5253_104_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	104	0	1	01	01	H5253_104_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1104.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	01	01	H5253_105_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	01	01	H5253_105_0	6	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	01	01	H5253_105_0	6	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	105	0	1	01	01	H5253_105_0	6	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	105	0	1	01	01	H5253_105_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	105	0	1	01	01	H5253_105_0	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				922.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	001	0	1	01	01	H5262_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												
H5262	001	0	1	01	01	H5262_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												
H5262	001	0	1	01	01	H5262_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												
H5262	001	0	1	01	01	H5262_001_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				46.98	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	3	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												
H5262	003	0	1	01	01	H5262_003_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												
H5262	003	0	1	01	01	H5262_003_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												
H5262	003	0	1	01	01	H5262_003_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												
H5262	003	0	1	01	01	H5262_003_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				43.75	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	3	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												
H5262	007	0	1	01	01	H5262_007_0	1	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	1	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	1	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	1	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				45.85	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	1	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												
H5262	008	0	1	01	01	H5262_008_0	1	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	1	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	1	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	1	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				52.32	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	1	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												
H5262	011	0	1	01	01	H5262_011_0	1	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																					4.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	011	0	1	01	01	H5262_011_0	1	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																					12.00																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	1	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	1	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				53.69	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	1	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												
H5262	012	0	1	01	01	H5262_012_0	2	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																					4.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	012	0	1	01	01	H5262_012_0	2	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																					12.00																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	2	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	2	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				50.00	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	2	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												
H5262	018	0	1	01	01	H5262_018_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												
H5262	018	0	1	01	01	H5262_018_0	3	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	018	0	1	01	01	H5262_018_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	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	018	0	1	01	01	H5262_018_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				47.02	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	018	0	1	01	01	H5262_018_0	3	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												
H5262	019	0	1	01	01	H5262_019_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	019	0	1	01	01	H5262_019_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	019	0	1	01	01	H5262_019_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	019	0	1	01	01	H5262_019_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				43.76	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	019	0	1	01	01	H5262_019_0	4	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												
H5273	001	0	1	01	01	H5273_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	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5273	001	0	1	01	01	H5273_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	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5273	001	0	1	01	01	H5273_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	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												
H5273	001	0	1	01	01	H5273_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	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												
H5273	001	0	1	01	01	H5273_001_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 Drug, Specialty Tier												
H5273	002	0	1	01	01	H5273_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	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5273	002	0	1	01	01	H5273_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	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5273	002	0	1	01	01	H5273_002_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																			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												
H5273	002	0	1	01	01	H5273_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	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												
H5273	002	0	1	01	01	H5273_002_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 Drug, Specialty Tier												
H5273	003	0	1	01	01	H5273_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	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5273	003	0	1	01	01	H5273_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	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5273	003	0	1	01	01	H5273_003_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																			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												
H5273	003	0	1	01	01	H5273_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	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												
H5273	003	0	1	01	01	H5273_003_0	6	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												
H5280	001	0	1	48	05	H5280_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			
H5280	001	0	1	48	05	H5280_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	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	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			
H5294	002	1	1	01	01	H5294_002_1	5	Preferred Generic	3	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 Drug, Specialty Tier, Select Care Drugs												
H5294	002	1	1	01	01	H5294_002_1	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	1	1	01	01	H5294_002_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																			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	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	1	1	01	01	H5294_002_1	5	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												
H5294	002	1	1	01	01	H5294_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	002	2	1	01	01	H5294_002_2	5	Preferred Generic	3	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 Drug, Specialty Tier, Select Care Drugs												
H5294	002	2	1	01	01	H5294_002_2	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	2	1	01	01	H5294_002_2	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	2	1	01	01	H5294_002_2	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	2	1	01	01	H5294_002_2	5	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												
H5294	002	2	1	01	01	H5294_002_2	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												
H5294	002	3	1	01	01	H5294_002_3	5	Preferred Generic	3	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 Drug, Specialty Tier, Select Care Drugs												
H5294	002	3	1	01	01	H5294_002_3	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	3	1	01	01	H5294_002_3	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	3	1	01	01	H5294_002_3	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	3	1	01	01	H5294_002_3	5	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												
H5294	002	3	1	01	01	H5294_002_3	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												
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	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 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					31																				31																	31			31								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												
H5294	006	0	1	01	01	H5294_006_0	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	006	0	1	01	01	H5294_006_0	5	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	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 Drug, Specialty Tier, Select Care Drugs												
H5294	006	0	1	01	01	H5294_006_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																			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	006	0	1	01	01	H5294_006_0	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	006	0	1	01	01	H5294_006_0	5	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												
H5294	006	0	1	01	01	H5294_006_0	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												
H5294	007	0	1	01	01	H5294_007_0	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	007	0	1	01	01	H5294_007_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																			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	007	0	1	01	01	H5294_007_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																			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	007	0	1	01	01	H5294_007_0	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	007	0	1	01	01	H5294_007_0	5	Specialty Tier	3	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, Select Care Drugs												
H5294	007	0	1	01	01	H5294_007_0	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												
H5294	008	0	1	01	01	H5294_008_0	5	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	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	008	0	1	01	01	H5294_008_0	5	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	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 Drug, Specialty Tier, Select Care Drugs												
H5294	008	0	1	01	01	H5294_008_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																			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	008	0	1	01	01	H5294_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		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	008	0	1	01	01	H5294_008_0	5	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												
H5294	008	0	1	01	01	H5294_008_0	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	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	011	0	1	01	01	H5302_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5302	011	0	1	01	01	H5302_011_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	011	0	1	01	01	H5302_011_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	10.00					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		
H5302	011	0	1	01	01	H5302_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	011	0	1	01	01	H5302_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												
H5302	011	0	1	01	01	H5302_011_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												
H5302	012	0	1	01	01	H5302_012_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	012	0	1	01	01	H5302_012_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5302	012	0	1	01	01	H5302_012_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	012	0	1	01	01	H5302_012_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	10.00					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		
H5302	012	0	1	01	01	H5302_012_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	012	0	1	01	01	H5302_012_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												
H5302	012	0	1	01	01	H5302_012_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												
H5322	024	0	1	01	01	H5322_024_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				935.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	001	0	1	01	01	H5325_001_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												
H5325	001	0	1	01	01	H5325_001_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		
H5325	001	0	1	01	01	H5325_001_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	001	0	1	01	01	H5325_001_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5325	001	0	1	01	01	H5325_001_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												
H5325	001	0	1	01	01	H5325_001_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												
H5325	001	0	1	01	01	H5325_001_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												
H5325	002	0	1	01	01	H5325_002_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												
H5325	002	0	1	01	01	H5325_002_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		
H5325	002	0	1	01	01	H5325_002_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	002	0	1	01	01	H5325_002_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5325	002	0	1	01	01	H5325_002_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												
H5325	002	0	1	01	01	H5325_002_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												
H5325	002	0	1	01	01	H5325_002_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												
H5325	003	0	1	01	01	H5325_003_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												
H5325	003	0	1	01	01	H5325_003_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		
H5325	003	0	1	01	01	H5325_003_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	003	0	1	01	01	H5325_003_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5325	003	0	1	01	01	H5325_003_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												
H5325	003	0	1	01	01	H5325_003_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												
H5325	003	0	1	01	01	H5325_003_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												
H5325	004	0	1	01	01	H5325_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	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												
H5325	004	0	1	01	01	H5325_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	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		
H5325	004	0	1	01	01	H5325_004_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	004	0	1	01	01	H5325_004_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5325	004	0	1	01	01	H5325_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																			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												
H5325	004	0	1	01	01	H5325_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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	004	0	1	01	01	H5325_004_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												
H5325	005	0	1	01	01	H5325_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	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												
H5325	005	0	1	01	01	H5325_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	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		
H5325	005	0	1	01	01	H5325_005_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	005	0	1	01	01	H5325_005_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5325	005	0	1	01	01	H5325_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																			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												
H5325	005	0	1	01	01	H5325_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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5325	005	0	1	01	01	H5325_005_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												
H5337	001	0	1	01	01	H5337_001_0	3	Preferred Generic	3	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	2.00	4.00	6.00																			2.00	4.00	0.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5337	001	0	1	01	01	H5337_001_0	3	Generic	3	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	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 Drug, Specialty Tier												
H5337	001	0	1	01	01	H5337_001_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																			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												
H5337	001	0	1	01	01	H5337_001_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			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5337	001	0	1	01	01	H5337_001_0	3	Specialty Tier	3	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												
H5355	001	0	1	48	05	H5355_001_0	3	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	0.00	3.40	0.00	3.40	0.00	3.40	0.00	3.40			
H5355	001	0	1	48	05	H5355_001_0	3	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	0.00	8.50	0.00	8.50	0.00	8.50	0.00	8.50			
H5355	001	0	1	48	05	H5355_001_0	3	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			
H5377	001	0	1	01	01	H5377_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					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												
H5377	001	0	1	01	01	H5377_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_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												
H5386	003	0	1	01	01	H5386_003_0	3	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, Select Care Drugs												
H5386	003	0	1	01	01	H5386_003_0	3	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, Select Care Drugs												
H5386	003	0	1	01	01	H5386_003_0	3	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, Select Care Drugs												
H5386	003	0	1	01	01	H5386_003_0	3	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, Select Care Drugs												
H5386	003	0	1	01	01	H5386_003_0	3	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				452.32	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	003	0	1	01	01	H5386_003_0	3	Select Care Drugs	4	01	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		34	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	3	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, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	3	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, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	3	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, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	3	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, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	3	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				416.83	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	3	Select Care Drugs	4	01	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		34	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5410	001	0	1	01	01	H5410_001_0	5	Generic	4	11	3	2	1	1		110	01			1				30		90	2	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	5	Generic	4	11	3	2	1	3		110	01			1				30		90	2	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	5	Brand	4	10	1	2	2	1		110	01			1				30		90	2	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	5	Brand	4	10	1	2	2	3		110	01			1				30		90	2	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										2		
H5410	001	0	1	01	01	H5410_001_0	5	Specialty Tier	4	11	1	1	3	1		010	01			1				30											30		31											874.72	33						510.54	33																							33			33								Generic, Brand, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	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	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	6	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	24.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	6	Preferred Brand	4	11	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											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												
H5410	018	0	1	01	01	H5410_018_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											70.78	50	50	50				75.48	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	6	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											597.96	27						452.88	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	024	0	1	01	01	H5410_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								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												
H5410	024	0	1	01	01	H5410_024_0	7	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					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		
H5410	024	0	1	01	01	H5410_024_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5410	024	0	1	01	01	H5410_024_0	7	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5410	024	0	1	01	01	H5410_024_0	7	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		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												
H5410	024	0	1	01	01	H5410_024_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											100.00	200.00	300.00				95.00	190.00	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												
H5410	024	0	1	01	01	H5410_024_0	7	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											798.71	33						602.92	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5420	001	0	1	01	01	H5420_001_0	2	Generic	4	01	3	2	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	2	Generic	4	01	3	2	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5420	001	0	1	01	01	H5420_001_0	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				730.00	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	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5420	003	0	1	01	01	H5420_003_0	2	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	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												
H5420	003	0	1	01	01	H5420_003_0	2	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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										1		3
H5420	003	0	1	01	01	H5420_003_0	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				682.00	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	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5420	006	0	1	01	01	H5420_006_0	2	Generic	4	01	3	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	2	Generic	4	01	3	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5420	006	0	1	01	01	H5420_006_0	2	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				42.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				55.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	2	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				762.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5422	007	0	1	01	01	H5422_007_0	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								5.00	10.00	15.00					5.00	10.00	15.00					5.00		15.00																5.00				5.00			0.17	0.17	0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								46.00	92.00	138.00					46.00	92.00	138.00					46.00		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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H5422	007	0	1	01	01	H5422_007_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	8	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00		10.00																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	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	8	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	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5422	011	0	1	01	01	H5422_011_0	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		8.00																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												
H5422	011	0	1	01	01	H5422_011_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								16.00	32.00	48.00					11.00	22.00	33.00					11.00		22.00																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												
H5422	011	0	1	01	01	H5422_011_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	011	0	1	01	01	H5422_011_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	011	0	1	01	01	H5422_011_0	11	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												
H5422	011	0	1	01	01	H5422_011_0	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	4	Preferred Generic	4	11	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	0.00																9.00				9.00			0.30	0.07	0.07			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	001	0	1	01	01	H5425_001_0	4	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					5.00	10.00	10.00					5.00	10.00	0.00																14.00				14.00			0.47	0.17	0.17			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	001	0	1	01	01	H5425_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	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	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	001	0	1	01	01	H5425_001_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	004	0	1	01	01	H5425_004_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					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	004	0	1	01	01	H5425_004_0	5	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	004	0	1	01	01	H5425_004_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					3.00	6.00	6.00					3.00	6.00	0.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	004	0	1	01	01	H5425_004_0	5	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					3.00	6.00	6.00					3.00	6.00	0.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	004	0	1	01	01	H5425_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								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	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	004	0	1	01	01	H5425_004_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	005	0	1	01	01	H5425_005_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					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	005	0	1	01	01	H5425_005_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	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	005	0	1	01	01	H5425_005_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	005	0	1	01	01	H5425_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		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	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	006	0	1	01	01	H5425_006_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	006	0	1	01	01	H5425_006_0	5	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	006	0	1	01	01	H5425_006_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	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	006	0	1	01	01	H5425_006_0	5	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					5.00	10.00	10.00					5.00	10.00	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	006	0	1	01	01	H5425_006_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	006	0	1	01	01	H5425_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		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	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	007	0	1	01	01	H5425_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								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	007	0	1	01	01	H5425_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								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	007	0	1	01	01	H5425_007_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	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	007	0	1	01	01	H5425_007_0	5	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					5.00	10.00	10.00					5.00	10.00	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	007	0	1	01	01	H5425_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	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	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	007	0	1	01	01	H5425_007_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	008	0	1	01	01	H5425_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								7.00	14.00	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	5	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	008	0	1	01	01	H5425_008_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	5	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	008	0	1	01	01	H5425_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	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	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	008	0	1	01	01	H5425_008_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	009	0	1	01	01	H5425_009_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					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	009	0	1	01	01	H5425_009_0	5	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	009	0	1	01	01	H5425_009_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	009	0	1	01	01	H5425_009_0	5	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	009	0	1	01	01	H5425_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	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	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	009	0	1	01	01	H5425_009_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	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								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	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								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	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											5.02	25	25	25				5.02	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											61.83	25	25	25				61.83	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											71.52	25	25	25				71.52	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	4	Preferred Generic	4	11	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	0.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	019	0	1	01	01	H5425_019_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					5.00	10.00	10.00					5.00	10.00	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	019	0	1	01	01	H5425_019_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	019	0	1	01	01	H5425_019_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	019	0	1	01	01	H5425_019_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	020	0	1	01	01	H5425_020_0	4	Preferred Generic	4	11	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	0.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	020	0	1	01	01	H5425_020_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					5.00	10.00	10.00					5.00	10.00	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	020	0	1	01	01	H5425_020_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	020	0	1	01	01	H5425_020_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	020	0	1	01	01	H5425_020_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	028	0	1	01	01	H5425_028_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	028	0	1	01	01	H5425_028_0	5	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	028	0	1	01	01	H5425_028_0	5	Generic	4	11	1	2	2	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	0.00																9.00				9.00			0.30	0.07	0.07			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	028	0	1	01	01	H5425_028_0	5	Generic	4	11	1	2	2	3		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	0.00																9.00				9.00			0.30	0.07	0.07			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	028	0	1	01	01	H5425_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	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	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	028	0	1	01	01	H5425_028_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	029	0	1	01	01	H5425_029_0	4	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	029	0	1	01	01	H5425_029_0	4	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	029	0	1	01	01	H5425_029_0	4	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											5.41	25	25	25				5.41	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	4	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											58.57	25	25	25				58.57	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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											68.25	25	25	25				68.25	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	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	030	0	1	01	01	H5425_030_0	4	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	4	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	4	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											5.05	25	25	25				5.05	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	4	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											58.77	25	25	25				58.77	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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											65.62	25	25	25				65.62	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	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	031	0	1	01	01	H5425_031_0	4	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	031	0	1	01	01	H5425_031_0	4	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	031	0	1	01	01	H5425_031_0	4	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											4.83	25	25	25				4.83	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	4	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											59.25	25	25	25				59.25	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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											65.16	25	25	25				65.16	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	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	033	0	1	01	01	H5425_033_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					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	033	0	1	01	01	H5425_033_0	5	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	033	0	1	01	01	H5425_033_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	033	0	1	01	01	H5425_033_0	5	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	033	0	1	01	01	H5425_033_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	033	0	1	01	01	H5425_033_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	033	0	1	01	01	H5425_033_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	034	0	1	01	01	H5425_034_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	034	0	1	01	01	H5425_034_0	5	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	034	0	1	01	01	H5425_034_0	5	Generic	4	11	1	2	2	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	0.00																9.00				9.00			0.30	0.07	0.07			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	034	0	1	01	01	H5425_034_0	5	Generic	4	11	1	2	2	3		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	0.00																9.00				9.00			0.30	0.07	0.07			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	034	0	1	01	01	H5425_034_0	5	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	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	034	0	1	01	01	H5425_034_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	040	0	1	01	01	H5425_040_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	040	0	1	01	01	H5425_040_0	5	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											5.86	25	25	25				5.86	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	5	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											59.12	25	25	25				59.12	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	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	040	0	1	01	01	H5425_040_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	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								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	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											6.03	25	25	25				6.03	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											58.39	25	25	25				58.39	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											75.88	25	25	25				75.88	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	052	0	1	01	01	H5425_052_0	4	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					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	052	0	1	01	01	H5425_052_0	4	Generic	4	11	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					10.00	20.00	0.00																17.00				17.00			0.57	0.33	0.33			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	052	0	1	01	01	H5425_052_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	052	0	1	01	01	H5425_052_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	052	0	1	01	01	H5425_052_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	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								7.00	14.00	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	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								7.00	14.00	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	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								17.00	34.00	34.00					10.00	20.00	20.00					10.00	20.00	0.00																17.00				17.00			0.57	0.33	0.33			0.55	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								7.00	14.00	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	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								7.00	14.00	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	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								17.00	34.00	34.00					10.00	20.00	20.00					10.00	20.00	0.00																17.00				17.00			0.57	0.33	0.33			0.55	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	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					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	055	0	1	01	01	H5425_055_0	5	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	055	0	1	01	01	H5425_055_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	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	055	0	1	01	01	H5425_055_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	055	0	1	01	01	H5425_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	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	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	061	0	1	01	01	H5425_061_0	5	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	18.00					2.00	4.00	4.00					2.00	4.00	0.00																9.00				9.00			0.30	0.07	0.07			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	061	0	1	01	01	H5425_061_0	5	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	18.00					2.00	4.00	4.00					2.00	4.00	0.00																9.00				9.00			0.30	0.07	0.07			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	061	0	1	01	01	H5425_061_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	061	0	1	01	01	H5425_061_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	061	0	1	01	01	H5425_061_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	061	0	1	01	01	H5425_061_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	064	0	1	01	01	H5425_064_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	064	0	1	01	01	H5425_064_0	5	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	064	0	1	01	01	H5425_064_0	5	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	064	0	1	01	01	H5425_064_0	5	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	064	0	1	01	01	H5425_064_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	064	0	1	01	01	H5425_064_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	064	0	1	01	01	H5425_064_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	065	0	1	01	01	H5425_065_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	065	0	1	01	01	H5425_065_0	5	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	065	0	1	01	01	H5425_065_0	5	Generic	4	11	3	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	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	065	0	1	01	01	H5425_065_0	5	Generic	4	11	3	2	2	3		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	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	065	0	1	01	01	H5425_065_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	065	0	1	01	01	H5425_065_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	065	0	1	01	01	H5425_065_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	066	0	1	01	01	H5425_066_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	066	0	1	01	01	H5425_066_0	5	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	066	0	1	01	01	H5425_066_0	5	Generic	4	11	3	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	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	066	0	1	01	01	H5425_066_0	5	Generic	4	11	3	2	2	3		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	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	066	0	1	01	01	H5425_066_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	066	0	1	01	01	H5425_066_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	066	0	1	01	01	H5425_066_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	067	0	1	01	01	H5425_067_0	6	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					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	6	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					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	067	0	1	01	01	H5425_067_0	6	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	6	Generic	4	11	3	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	067	0	1	01	01	H5425_067_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	067	0	1	01	01	H5425_067_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	067	0	1	01	01	H5425_067_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	068	0	1	01	01	H5425_068_0	6	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					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	6	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					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	068	0	1	01	01	H5425_068_0	6	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	6	Generic	4	11	3	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	28.00					7.00	14.00	14.00					7.00	14.00	0.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	068	0	1	01	01	H5425_068_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	068	0	1	01	01	H5425_068_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	068	0	1	01	01	H5425_068_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												
H5427	059	0	1	01	01	H5427_059_0	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	8	Preferred Generic	4	11	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	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	8	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	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	8	Preferred Generic	4	11	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	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	8	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	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	8	Preferred Generic	4	11	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	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	8	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	8	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	8	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	9	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	9	Preferred Generic	4	11	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	9	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	9	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	9	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	9	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	9	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	9	Preferred Generic	4	11	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	9	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	9	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	9	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	078	0	1	01	01	H5427_078_0	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	078	0	1	01	01	H5427_078_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	078	0	1	01	01	H5427_078_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	078	0	1	01	01	H5427_078_0	8	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	082	0	1	01	01	H5427_082_0	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	8	Preferred Generic	4	11	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	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	8	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	8	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	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	8	Preferred Generic	4	11	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	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	8	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	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	8	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	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	8	Preferred Generic	4	11	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	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	8	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	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	8	Preferred Generic	4	11	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	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	8	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	9	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	9	Preferred Generic	4	11	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	9	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	9	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	9	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	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	8	Preferred Generic	4	11	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	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	8	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	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	8	Preferred Generic	4	11	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	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	8	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	9	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	9	Preferred Generic	4	11	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	9	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	9	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	9	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	096	0	1	01	01	H5427_096_0	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	096	0	1	01	01	H5427_096_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	096	0	1	01	01	H5427_096_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	096	0	1	01	01	H5427_096_0	8	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	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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	4	Generic	3	11	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		0.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5430	001	0	1	01	01	H5430_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																									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												
H5430	001	0	1	01	01	H5430_001_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				68.17	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	4	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												
H5431	001	0	1	01	01	H5431_001_0	5	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	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	5	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	0.00	0.00			0.00	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	5	Generic	4	01	1	2	2	1		110	01	110		1				30		90	2	2	30		90				30		31								10.00		20.00					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, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	5	Generic	4	01	1	2	2	3		110	01	110		1				30		90	2	2	30		90				30		31								10.00		20.00					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, Supplemental Brand and Generic Drugs										1		
H5431	001	0	1	01	01	H5431_001_0	5	Preferred Brand	4	10	1	2	3	1		010	01	010		1				30					30						30		31								25.00							0.00							0.00																		25.00				25.00			0.83	0.00	0.00			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	5	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		31								50.00							25.00							25.00																		50.00				25.00			1.67	0.83	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1260.97	33						750.41	33						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	5	Supplemental Brand and Generic Drugs	4	11	2	2	6	1		010	01	010		1				30					30						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, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	5	Preferred Generic	4	01	1	1	1	1	110		01	110		1	30		90				2	2	30		90				30		31				2.14	25		25																		25		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	5	Generic	4	01	1	1	2	1	110		01	110		1	30		90				2	2	30		90				30		31				10.22	25		25																		25		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	5	Preferred Brand	4	10	1	1	3	1	010		01	010		1	30								30						30		31				74.91	25																				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	5	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		31				55.65	25																				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	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				606.55	25																				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	5	Supplemental Brand and Generic Drugs	4	11	2	2	6	1	010		01	010		1	30								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	5	Supplemental Brand and Generic Drugs	4	11	2	2	6	3	010		01	010		1	30								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										1		
H5431	012	0	1	01	01	H5431_012_0	5	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	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	012	0	1	01	01	H5431_012_0	5	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	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	5	Generic	4	01	1	2	2	1		110	01	110		1				30		90	2	2	30		90				30		31								10.00		20.00					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, Supplemental Brand and Generic Drugs												
H5431	012	0	1	01	01	H5431_012_0	5	Generic	4	01	1	2	2	3		110	01	110		1				30		90	2	2	30		90				30		31								10.00		20.00					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, Supplemental Brand and Generic Drugs										1		
H5431	012	0	1	01	01	H5431_012_0	5	Preferred Brand	4	10	1	2	3	1		010	01	010		1				30					30						30		31								25.00							15.00							15.00																		25.00				25.00			0.83	0.50	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	5	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		31								50.00							30.00							30.00																		50.00				50.00			1.67	1.00	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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1239.16	33						580.78	33						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	5	Supplemental Brand and Generic Drugs	4	11	2	2	6	1		010	01	010		1				30					30						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, Supplemental Brand and Generic Drugs												
H5433	001	0	1	01	01	H5433_001_0	6	Generic	4	11	1	2	1	1	010		01			1	30														30		31	0.00																																							0.00				0.00									Generic, Brand												
H5433	001	0	1	01	01	H5433_001_0	6	Generic	4	11	1	2	1	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Generic, Brand										1		
H5433	001	0	1	01	01	H5433_001_0	6	Brand	4	11	1	2	2	1	010		01			1	30														30		31	0.00																																							0.00				0.00									Generic, Brand												
H5434	002	0	1	04	01	H5434_002_0	8	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	8	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	8	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	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		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	8	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	8	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	8	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	8	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		
H5434	023	0	1	04	01	H5434_023_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, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_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, Select Care Drugs										1		
H5434	023	0	1	04	01	H5434_023_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		30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_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, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_0	8	Non-Preferred Drug	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				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				599.05	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	024	0	1	04	01	H5434_024_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, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_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, Select Care Drugs										1		
H5434	024	0	1	04	01	H5434_024_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		30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_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, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_0	8	Non-Preferred Drug	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				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_0	8	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				599.05	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	025	0	1	04	01	H5434_025_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, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_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, Select Care Drugs										1		
H5434	025	0	1	04	01	H5434_025_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		30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_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																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_0	10	Non-Preferred Drug	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				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				599.05	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5435	024	0	1	09	04	H5435_024_0	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	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						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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				819.00	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	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	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_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					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 Drug, Specialty Tier, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_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	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_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					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 Drug, Specialty Tier, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_0	5	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, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_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 Drug, Specialty Tier, Select Care Drugs												
H5439	013	0	1	04	01	H5439_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								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 Drug, Specialty Tier, Select Care Drugs												
H5439	013	0	1	04	01	H5439_013_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					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 Drug, Specialty Tier, Select Care Drugs												
H5439	013	0	1	04	01	H5439_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					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 Drug, Specialty Tier, Select Care Drugs												
H5439	013	0	1	04	01	H5439_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					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 Drug, Specialty Tier, Select Care Drugs												
H5439	013	0	1	04	01	H5439_013_0	5	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, Select Care Drugs												
H5439	013	0	1	04	01	H5439_013_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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	1	1	04	01	H5439_014_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	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	014	1	1	04	01	H5439_014_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	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	014	1	1	04	01	H5439_014_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	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	014	1	1	04	01	H5439_014_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					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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	1	1	04	01	H5439_014_1	5	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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	1	1	04	01	H5439_014_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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	2	1	04	01	H5439_014_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	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	014	2	1	04	01	H5439_014_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	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	014	2	1	04	01	H5439_014_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	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	014	2	1	04	01	H5439_014_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					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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	2	1	04	01	H5439_014_2	5	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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	2	1	04	01	H5439_014_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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	3	1	04	01	H5439_014_3	6	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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	3	1	04	01	H5439_014_3	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	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	014	3	1	04	01	H5439_014_3	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	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	014	3	1	04	01	H5439_014_3	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					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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	3	1	04	01	H5439_014_3	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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	3	1	04	01	H5439_014_3	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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	4	1	04	01	H5439_014_4	6	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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	4	1	04	01	H5439_014_4	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	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	014	4	1	04	01	H5439_014_4	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	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	014	4	1	04	01	H5439_014_4	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					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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	4	1	04	01	H5439_014_4	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 Drug, Specialty Tier, Select Care Drugs												
H5439	014	4	1	04	01	H5439_014_4	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 Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_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								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 Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_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	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_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	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_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		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 Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_0	5	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, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_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 Drug, Specialty Tier, Select Care Drugs												
H5439	016	1	1	04	01	H5439_016_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	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	016	1	1	04	01	H5439_016_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	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	016	1	1	04	01	H5439_016_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	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	016	1	1	04	01	H5439_016_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					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 Drug, Specialty Tier, Select Care Drugs												
H5439	016	1	1	04	01	H5439_016_1	5	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 Drug, Specialty Tier, Select Care Drugs												
H5439	016	1	1	04	01	H5439_016_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 Drug, Specialty Tier, Select Care Drugs												
H5439	016	2	1	04	01	H5439_016_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	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	016	2	1	04	01	H5439_016_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	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	016	2	1	04	01	H5439_016_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	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	016	2	1	04	01	H5439_016_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					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 Drug, Specialty Tier, Select Care Drugs												
H5439	016	2	1	04	01	H5439_016_2	5	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 Drug, Specialty Tier, Select Care Drugs												
H5439	016	2	1	04	01	H5439_016_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 Drug, Specialty Tier, Select Care Drugs												
H5441	001	0	1	48	05	H5441_001_0	4	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	4	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	4	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			
H5454	001	0	1	01	01	H5454_001_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	3.00		9.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	8	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	12.00		36.00																					0.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	8	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					131.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	8	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					290.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				50.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	002	0	1	01	01	H5454_002_0	8	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	3.00		9.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	002	0	1	01	01	H5454_002_0	8	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	12.00		36.00																					0.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	002	0	1	01	01	H5454_002_0	8	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					131.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	002	0	1	01	01	H5454_002_0	8	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					290.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	002	0	1	01	01	H5454_002_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				50.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	003	0	1	01	01	H5454_003_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	003	0	1	01	01	H5454_003_0	9	Generic	4	01	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	003	0	1	01	01	H5454_003_0	9	Preferred Brand	4	10	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	003	0	1	01	01	H5454_003_0	9	Non-Preferred Drug	4	10	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	003	0	1	01	01	H5454_003_0	9	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				50.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	004	0	1	01	01	H5454_004_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	004	0	1	01	01	H5454_004_0	8	Generic	4	01	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	004	0	1	01	01	H5454_004_0	8	Preferred Brand	4	10	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	004	0	1	01	01	H5454_004_0	8	Non-Preferred Drug	4	10	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	004	0	1	01	01	H5454_004_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				50.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5471	064	0	1	01	01	H5471_064_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	064	0	1	01	01	H5471_064_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	064	0	1	01	01	H5471_064_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	064	0	1	01	01	H5471_064_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	064	0	1	01	01	H5471_064_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	064	0	1	01	01	H5471_064_0	5	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	064	0	1	01	01	H5471_064_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	065	0	1	01	01	H5471_065_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	065	0	1	01	01	H5471_065_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	065	0	1	01	01	H5471_065_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	065	0	1	01	01	H5471_065_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	065	0	1	01	01	H5471_065_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	065	0	1	01	01	H5471_065_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	065	0	1	01	01	H5471_065_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	066	0	1	01	01	H5471_066_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	066	0	1	01	01	H5471_066_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	066	0	1	01	01	H5471_066_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	066	0	1	01	01	H5471_066_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	066	0	1	01	01	H5471_066_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	066	0	1	01	01	H5471_066_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	066	0	1	01	01	H5471_066_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	067	0	1	01	01	H5471_067_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	067	0	1	01	01	H5471_067_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	067	0	1	01	01	H5471_067_0	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				1	2							30		34				53.98	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				42.35	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	6	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	90				1	2							30		34	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	068	0	1	01	01	H5471_068_0	6	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	90				1	2							30		34	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	068	0	1	01	01	H5471_068_0	6	Generic	4	01	1	2	2	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	068	0	1	01	01	H5471_068_0	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				1	2							30		34				70.53	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				51.07	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	069	0	1	01	01	H5471_069_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	069	0	1	01	01	H5471_069_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	069	0	1	01	01	H5471_069_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	069	0	1	01	01	H5471_069_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	069	0	1	01	01	H5471_069_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	069	0	1	01	01	H5471_069_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	069	0	1	01	01	H5471_069_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	069	0	1	01	01	H5471_069_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	069	0	1	01	01	H5471_069_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	070	0	1	01	01	H5471_070_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	070	0	1	01	01	H5471_070_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	070	0	1	01	01	H5471_070_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	070	0	1	01	01	H5471_070_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	070	0	1	01	01	H5471_070_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	070	0	1	01	01	H5471_070_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	070	0	1	01	01	H5471_070_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	070	0	1	01	01	H5471_070_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	070	0	1	01	01	H5471_070_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	071	0	1	01	01	H5471_071_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	071	0	1	01	01	H5471_071_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	071	0	1	01	01	H5471_071_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	071	0	1	01	01	H5471_071_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	071	0	1	01	01	H5471_071_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	071	0	1	01	01	H5471_071_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	071	0	1	01	01	H5471_071_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	072	0	1	01	01	H5471_072_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	072	0	1	01	01	H5471_072_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	072	0	1	01	01	H5471_072_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	072	0	1	01	01	H5471_072_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	072	0	1	01	01	H5471_072_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	072	0	1	01	01	H5471_072_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	072	0	1	01	01	H5471_072_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	073	0	1	01	01	H5471_073_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	073	0	1	01	01	H5471_073_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	073	0	1	01	01	H5471_073_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	073	0	1	01	01	H5471_073_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	073	0	1	01	01	H5471_073_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	073	0	1	01	01	H5471_073_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	073	0	1	01	01	H5471_073_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	073	0	1	01	01	H5471_073_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	073	0	1	01	01	H5471_073_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	074	0	1	01	01	H5471_074_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	074	0	1	01	01	H5471_074_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	074	0	1	01	01	H5471_074_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	074	0	1	01	01	H5471_074_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	074	0	1	01	01	H5471_074_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	074	0	1	01	01	H5471_074_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	074	0	1	01	01	H5471_074_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	075	0	1	01	01	H5471_075_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	075	0	1	01	01	H5471_075_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	075	0	1	01	01	H5471_075_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	075	0	1	01	01	H5471_075_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	075	0	1	01	01	H5471_075_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	075	0	1	01	01	H5471_075_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	075	0	1	01	01	H5471_075_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	075	0	1	01	01	H5471_075_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	075	0	1	01	01	H5471_075_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	076	0	1	01	01	H5471_076_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	076	0	1	01	01	H5471_076_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	076	0	1	01	01	H5471_076_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	076	0	1	01	01	H5471_076_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	076	0	1	01	01	H5471_076_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	076	0	1	01	01	H5471_076_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	076	0	1	01	01	H5471_076_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	077	0	1	01	01	H5471_077_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	077	0	1	01	01	H5471_077_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	077	0	1	01	01	H5471_077_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	077	0	1	01	01	H5471_077_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	077	0	1	01	01	H5471_077_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	077	0	1	01	01	H5471_077_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	077	0	1	01	01	H5471_077_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	078	0	1	01	01	H5471_078_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	078	0	1	01	01	H5471_078_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	078	0	1	01	01	H5471_078_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	078	0	1	01	01	H5471_078_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	078	0	1	01	01	H5471_078_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	078	0	1	01	01	H5471_078_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	078	0	1	01	01	H5471_078_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	079	0	1	01	01	H5471_079_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	079	0	1	01	01	H5471_079_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	079	0	1	01	01	H5471_079_0	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				1	2							30		34				56.14	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	079	0	1	01	01	H5471_079_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				43.87	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	079	0	1	01	01	H5471_079_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	080	0	1	01	01	H5471_080_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	080	0	1	01	01	H5471_080_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	080	0	1	01	01	H5471_080_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	080	0	1	01	01	H5471_080_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	080	0	1	01	01	H5471_080_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	080	0	1	01	01	H5471_080_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	080	0	1	01	01	H5471_080_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	080	0	1	01	01	H5471_080_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	080	0	1	01	01	H5471_080_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	081	0	1	01	01	H5471_081_0	6	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	90				1	2							30		34	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	081	0	1	01	01	H5471_081_0	6	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	90				1	2							30		34	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	081	0	1	01	01	H5471_081_0	6	Generic	4	01	1	2	2	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	081	0	1	01	01	H5471_081_0	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				1	2							30		34				56.41	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	081	0	1	01	01	H5471_081_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				44.33	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	081	0	1	01	01	H5471_081_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_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	082	0	1	01	01	H5471_082_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	082	0	1	01	01	H5471_082_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	082	0	1	01	01	H5471_082_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	082	0	1	01	01	H5471_082_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	082	0	1	01	01	H5471_082_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	082	0	1	01	01	H5471_082_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	083	0	1	01	01	H5471_083_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	083	0	1	01	01	H5471_083_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	083	0	1	01	01	H5471_083_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	083	0	1	01	01	H5471_083_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	083	0	1	01	01	H5471_083_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	083	0	1	01	01	H5471_083_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	083	0	1	01	01	H5471_083_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	084	0	1	01	01	H5471_084_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	084	0	1	01	01	H5471_084_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	084	0	1	01	01	H5471_084_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	084	0	1	01	01	H5471_084_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	084	0	1	01	01	H5471_084_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	084	0	1	01	01	H5471_084_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	084	0	1	01	01	H5471_084_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	085	0	1	01	01	H5471_085_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	085	0	1	01	01	H5471_085_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	085	0	1	01	01	H5471_085_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	085	0	1	01	01	H5471_085_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	085	0	1	01	01	H5471_085_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	085	0	1	01	01	H5471_085_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	085	0	1	01	01	H5471_085_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	085	0	1	01	01	H5471_085_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	085	0	1	01	01	H5471_085_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	086	0	1	01	01	H5471_086_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	086	0	1	01	01	H5471_086_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	086	0	1	01	01	H5471_086_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	086	0	1	01	01	H5471_086_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	086	0	1	01	01	H5471_086_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	086	0	1	01	01	H5471_086_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	086	0	1	01	01	H5471_086_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	087	0	1	01	01	H5471_087_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	087	0	1	01	01	H5471_087_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	087	0	1	01	01	H5471_087_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	087	0	1	01	01	H5471_087_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	087	0	1	01	01	H5471_087_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	087	0	1	01	01	H5471_087_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	087	0	1	01	01	H5471_087_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	088	0	1	01	01	H5471_088_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	088	0	1	01	01	H5471_088_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	088	0	1	01	01	H5471_088_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	088	0	1	01	01	H5471_088_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	088	0	1	01	01	H5471_088_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	088	0	1	01	01	H5471_088_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	088	0	1	01	01	H5471_088_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	089	0	1	01	01	H5471_089_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	089	0	1	01	01	H5471_089_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	089	0	1	01	01	H5471_089_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	089	0	1	01	01	H5471_089_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	089	0	1	01	01	H5471_089_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	089	0	1	01	01	H5471_089_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	089	0	1	01	01	H5471_089_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	090	0	1	01	01	H5471_090_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	090	0	1	01	01	H5471_090_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	090	0	1	01	01	H5471_090_0	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				1	2							30		34				56.50	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	090	0	1	01	01	H5471_090_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				44.13	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	090	0	1	01	01	H5471_090_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	091	0	1	01	01	H5471_091_0	6	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	90				1	2							30		34	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	091	0	1	01	01	H5471_091_0	6	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	90				1	2							30		34	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	091	0	1	01	01	H5471_091_0	6	Generic	4	01	1	2	2	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	091	0	1	01	01	H5471_091_0	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				1	2							30		34				56.76	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	091	0	1	01	01	H5471_091_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				44.58	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	091	0	1	01	01	H5471_091_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_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	092	0	1	01	01	H5471_092_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	092	0	1	01	01	H5471_092_0	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				1	2							30		34				57.05	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				44.53	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	6	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	90				1	2							30		34	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	093	0	1	01	01	H5471_093_0	6	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	90				1	2							30		34	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	093	0	1	01	01	H5471_093_0	6	Generic	4	01	1	2	2	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	093	0	1	01	01	H5471_093_0	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				1	2							30		34				57.30	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				44.98	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	094	0	1	01	01	H5471_094_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	094	0	1	01	01	H5471_094_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	094	0	1	01	01	H5471_094_0	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				1	2							30		34				56.55	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	094	0	1	01	01	H5471_094_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				44.16	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	094	0	1	01	01	H5471_094_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	095	0	1	01	01	H5471_095_0	6	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	90				1	2							30		34	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	095	0	1	01	01	H5471_095_0	6	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	90				1	2							30		34	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	095	0	1	01	01	H5471_095_0	6	Generic	4	01	1	2	2	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	095	0	1	01	01	H5471_095_0	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				1	2							30		34				56.80	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	095	0	1	01	01	H5471_095_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				44.61	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	095	0	1	01	01	H5471_095_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	096	0	1	01	01	H5471_096_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	096	0	1	01	01	H5471_096_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	096	0	1	01	01	H5471_096_0	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				1	2							30		34				58.69	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	096	0	1	01	01	H5471_096_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				45.73	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	096	0	1	01	01	H5471_096_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	097	0	1	01	01	H5471_097_0	6	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	90				1	2							30		34	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	097	0	1	01	01	H5471_097_0	6	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	90				1	2							30		34	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	097	0	1	01	01	H5471_097_0	6	Generic	4	01	1	2	2	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	097	0	1	01	01	H5471_097_0	6	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				1	2							30		34				58.91	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	097	0	1	01	01	H5471_097_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				46.17	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	097	0	1	01	01	H5471_097_0	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	098	0	1	01	01	H5471_098_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	098	0	1	01	01	H5471_098_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	098	0	1	01	01	H5471_098_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	098	0	1	01	01	H5471_098_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	098	0	1	01	01	H5471_098_0	6	Preferred Brand	4	10	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34				69.25	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	098	0	1	01	01	H5471_098_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				53.36	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	098	0	1	01	01	H5471_098_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	099	0	1	01	01	H5471_099_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	099	0	1	01	01	H5471_099_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	099	0	1	01	01	H5471_099_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	099	0	1	01	01	H5471_099_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	099	0	1	01	01	H5471_099_0	6	Preferred Brand	4	10	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34				68.70	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	099	0	1	01	01	H5471_099_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				53.16	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	099	0	1	01	01	H5471_099_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	100	0	1	01	01	H5471_100_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	100	0	1	01	01	H5471_100_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	100	0	1	01	01	H5471_100_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	100	0	1	01	01	H5471_100_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	100	0	1	01	01	H5471_100_0	6	Preferred Brand	4	10	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34				68.25	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	100	0	1	01	01	H5471_100_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				52.99	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	100	0	1	01	01	H5471_100_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	101	0	1	01	01	H5471_101_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	101	0	1	01	01	H5471_101_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	101	0	1	01	01	H5471_101_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	101	0	1	01	01	H5471_101_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	101	0	1	01	01	H5471_101_0	6	Preferred Brand	4	10	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34				71.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	101	0	1	01	01	H5471_101_0	6	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				54.01	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	101	0	1	01	01	H5471_101_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	001	0	1	01	01	H5475_001_0	13	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				5.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	001	0	1	01	01	H5475_001_0	13	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				10.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	001	0	1	01	01	H5475_001_0	13	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				50.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	001	0	1	01	01	H5475_001_0	13	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	001	0	1	01	01	H5475_001_0	13	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				250.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	001	0	1	01	01	H5475_001_0	13	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	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	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	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	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								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	8	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				5.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	004	0	1	01	01	H5475_004_0	8	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				10.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	004	0	1	01	01	H5475_004_0	8	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				50.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	004	0	1	01	01	H5475_004_0	8	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	004	0	1	01	01	H5475_004_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				250.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	004	0	1	01	01	H5475_004_0	8	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	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	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	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	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								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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	006	0	1	01	01	H5475_006_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	006	0	1	01	01	H5475_006_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	006	0	1	01	01	H5475_006_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	006	0	1	01	01	H5475_006_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	006	0	1	01	01	H5475_006_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												
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		10.00																					10.00																4.00				4.00		0.13						0.13	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	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	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	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								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	75.00																																							75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	008	0	1	01	01	H5475_008_0	8	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				5.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	008	0	1	01	01	H5475_008_0	8	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				10.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	008	0	1	01	01	H5475_008_0	8	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				50.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	008	0	1	01	01	H5475_008_0	8	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	008	0	1	01	01	H5475_008_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				250.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	008	0	1	01	01	H5475_008_0	8	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	009	0	1	01	01	H5475_009_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	009	0	1	01	01	H5475_009_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	009	0	1	01	01	H5475_009_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	009	0	1	01	01	H5475_009_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	009	0	1	01	01	H5475_009_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	010	0	1	01	01	H5475_010_0	8	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				5.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	010	0	1	01	01	H5475_010_0	8	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				10.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	010	0	1	01	01	H5475_010_0	8	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				50.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	010	0	1	01	01	H5475_010_0	8	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	010	0	1	01	01	H5475_010_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				250.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	010	0	1	01	01	H5475_010_0	8	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	011	0	1	01	01	H5475_011_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	011	0	1	01	01	H5475_011_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	011	0	1	01	01	H5475_011_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	011	0	1	01	01	H5475_011_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	011	0	1	01	01	H5475_011_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	012	0	1	01	01	H5475_012_0	8	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				5.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	012	0	1	01	01	H5475_012_0	8	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				10.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	012	0	1	01	01	H5475_012_0	8	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				50.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	012	0	1	01	01	H5475_012_0	8	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	012	0	1	01	01	H5475_012_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				250.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	012	0	1	01	01	H5475_012_0	8	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	013	0	1	01	01	H5475_013_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	013	0	1	01	01	H5475_013_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	013	0	1	01	01	H5475_013_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	013	0	1	01	01	H5475_013_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	013	0	1	01	01	H5475_013_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												
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	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	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	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	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								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	8	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				5.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	015	0	1	01	01	H5475_015_0	8	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				10.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	015	0	1	01	01	H5475_015_0	8	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				50.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	015	0	1	01	01	H5475_015_0	8	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	015	0	1	01	01	H5475_015_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				250.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	015	0	1	01	01	H5475_015_0	8	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	016	0	1	01	01	H5475_016_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	016	0	1	01	01	H5475_016_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	016	0	1	01	01	H5475_016_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	016	0	1	01	01	H5475_016_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	016	0	1	01	01	H5475_016_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	019	0	1	01	01	H5475_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	019	0	1	01	01	H5475_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	019	0	1	01	01	H5475_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	019	0	1	01	01	H5475_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	019	0	1	01	01	H5475_019_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	019	0	1	01	01	H5475_019_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	020	0	1	01	01	H5475_020_0	8	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				5.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	020	0	1	01	01	H5475_020_0	8	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				10.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	020	0	1	01	01	H5475_020_0	8	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				50.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	020	0	1	01	01	H5475_020_0	8	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	020	0	1	01	01	H5475_020_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				250.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	020	0	1	01	01	H5475_020_0	8	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												
H5475	021	0	1	01	01	H5475_021_0	8	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				5.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	021	0	1	01	01	H5475_021_0	8	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				10.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	021	0	1	01	01	H5475_021_0	8	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				50.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	021	0	1	01	01	H5475_021_0	8	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	021	0	1	01	01	H5475_021_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				250.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	021	0	1	01	01	H5475_021_0	8	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	022	0	1	01	01	H5475_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	022	0	1	01	01	H5475_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	022	0	1	01	01	H5475_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	022	0	1	01	01	H5475_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	022	0	1	01	01	H5475_022_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	022	0	1	01	01	H5475_022_0	8	Supplemental Drugs	4	10	2	2	6	1	010		01			1	30														30		31	60.00																																							60.00				60.00		2.00						1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	023	0	1	01	01	H5475_023_0	8	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				5.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	023	0	1	01	01	H5475_023_0	8	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				10.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	023	0	1	01	01	H5475_023_0	8	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				50.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	023	0	1	01	01	H5475_023_0	8	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	023	0	1	01	01	H5475_023_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				250.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	023	0	1	01	01	H5475_023_0	8	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	024	0	1	01	01	H5475_024_0	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	024	0	1	01	01	H5475_024_0	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	024	0	1	01	01	H5475_024_0	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	024	0	1	01	01	H5475_024_0	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	024	0	1	01	01	H5475_024_0	11	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	024	0	1	01	01	H5475_024_0	11	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	025	0	1	01	01	H5475_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	025	0	1	01	01	H5475_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	025	0	1	01	01	H5475_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	025	0	1	01	01	H5475_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	025	0	1	01	01	H5475_025_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	025	0	1	01	01	H5475_025_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	026	0	1	01	01	H5475_026_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	026	0	1	01	01	H5475_026_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	026	0	1	01	01	H5475_026_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	026	0	1	01	01	H5475_026_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	026	0	1	01	01	H5475_026_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	026	0	1	01	01	H5475_026_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												
H5475	027	0	1	01	01	H5475_027_0	8	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				5.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	027	0	1	01	01	H5475_027_0	8	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				10.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	027	0	1	01	01	H5475_027_0	8	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				50.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	027	0	1	01	01	H5475_027_0	8	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	027	0	1	01	01	H5475_027_0	8	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				250.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	027	0	1	01	01	H5475_027_0	8	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	028	0	1	01	01	H5475_028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	028	0	1	01	01	H5475_028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	028	0	1	01	01	H5475_028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	028	0	1	01	01	H5475_028_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	028	0	1	01	01	H5475_028_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5475	028	0	1	01	01	H5475_028_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												
H5496	005	0	1	01	01	H5496_005_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												
H5496	005	0	1	01	01	H5496_005_0	6	Preferred Generic	4	11	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	6	Generic	4	11	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	6	Generic	4	11	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	6	Preferred Brand	4	11	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	6	Non-Preferred Drug	4	11	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	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, Select Care Drugs												
H5496	005	0	1	01	01	H5496_005_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												
H5496	007	0	1	01	01	H5496_007_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												
H5496	007	0	1	01	01	H5496_007_0	5	Preferred Generic	4	11	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	5	Generic	4	11	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	5	Generic	4	11	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	5	Preferred Brand	4	11	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	5	Non-Preferred Drug	4	11	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	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												
H5496	009	0	1	01	01	H5496_009_0	5	Preferred Generic	4	11	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	5	Preferred Generic	4	11	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	5	Generic	4	11	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				4.45	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	009	0	1	01	01	H5496_009_0	5	Generic	4	11	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	5	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				79.14	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	009	0	1	01	01	H5496_009_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				36.04	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	009	0	1	01	01	H5496_009_0	5	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												
H5521	012	0	1	04	01	H5521_012_0	5	Preferred Generic	4	01	1	2	1	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	012	0	1	04	01	H5521_012_0	5	Preferred Generic	4	01	1	2	1	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	012	0	1	04	01	H5521_012_0	5	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	012	0	1	04	01	H5521_012_0	5	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	012	0	1	04	01	H5521_012_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	012	0	1	04	01	H5521_012_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	012	0	1	04	01	H5521_012_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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	015	0	1	04	01	H5521_015_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_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	10.00					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		
H5521	015	0	1	04	01	H5521_015_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_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	015	0	1	04	01	H5521_015_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	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								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	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								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	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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	33						1.00	33												33						33						33		33								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								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	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								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	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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	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						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	027	0	1	04	01	H5521_027_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_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	10.00					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		
H5521	027	0	1	04	01	H5521_027_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_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	027	0	1	04	01	H5521_027_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	033	0	1	04	01	H5521_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								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	3	Preferred Generic	4	01	1	2	1	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	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	033	0	1	04	01	H5521_033_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	033	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	033	0	1	04	01	H5521_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												
H5521	033	0	1	04	01	H5521_033_0	3	Specialty Tier	4	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												
H5521	037	0	1	04	01	H5521_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	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		
H5521	037	0	1	04	01	H5521_037_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_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	10.00					20.00			20.00			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	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_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												
H5521	037	0	1	04	01	H5521_037_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	040	0	1	04	01	H5521_040_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	040	0	1	04	01	H5521_040_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_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	10.00					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		
H5521	040	0	1	04	01	H5521_040_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_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	040	0	1	04	01	H5521_040_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	053	0	1	04	01	H5521_053_0	3	Preferred Generic	4	01	1	2	1	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	053	0	1	04	01	H5521_053_0	3	Preferred Generic	4	01	1	2	1	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	053	0	1	04	01	H5521_053_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	053	0	1	04	01	H5521_053_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	053	0	1	04	01	H5521_053_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_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	053	0	1	04	01	H5521_053_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	055	0	1	04	01	H5521_055_0	3	Preferred Generic	4	01	1	2	1	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	055	0	1	04	01	H5521_055_0	3	Preferred Generic	4	01	1	2	1	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	055	0	1	04	01	H5521_055_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	055	0	1	04	01	H5521_055_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_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	055	0	1	04	01	H5521_055_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	056	0	1	04	01	H5521_056_0	3	Preferred Generic	4	01	1	2	1	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	056	0	1	04	01	H5521_056_0	3	Preferred Generic	4	01	1	2	1	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	056	0	1	04	01	H5521_056_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	056	0	1	04	01	H5521_056_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	056	0	1	04	01	H5521_056_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_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	056	0	1	04	01	H5521_056_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	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								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	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								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	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	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	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	058	0	1	04	01	H5521_058_0	3	Preferred Generic	4	01	1	2	1	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	058	0	1	04	01	H5521_058_0	3	Preferred Generic	4	01	1	2	1	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	058	0	1	04	01	H5521_058_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	058	0	1	04	01	H5521_058_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	058	0	1	04	01	H5521_058_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	058	0	1	04	01	H5521_058_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	058	0	1	04	01	H5521_058_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	059	0	1	04	01	H5521_059_0	3	Preferred Generic	4	01	1	2	1	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	059	0	1	04	01	H5521_059_0	3	Preferred Generic	4	01	1	2	1	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	059	0	1	04	01	H5521_059_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	059	0	1	04	01	H5521_059_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	059	0	1	04	01	H5521_059_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	059	0	1	04	01	H5521_059_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	059	0	1	04	01	H5521_059_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	060	0	1	04	01	H5521_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								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	060	0	1	04	01	H5521_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								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	060	0	1	04	01	H5521_060_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	060	0	1	04	01	H5521_060_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	060	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	060	0	1	04	01	H5521_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												
H5521	060	0	1	04	01	H5521_060_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	076	0	1	04	01	H5521_076_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	076	0	1	04	01	H5521_076_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_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	10.00					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		
H5521	076	0	1	04	01	H5521_076_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_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	076	0	1	04	01	H5521_076_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	077	0	1	04	01	H5521_077_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	077	0	1	04	01	H5521_077_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_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	10.00					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		
H5521	077	0	1	04	01	H5521_077_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_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	077	0	1	04	01	H5521_077_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	081	0	1	04	01	H5521_081_0	3	Preferred Generic	4	01	1	2	1	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	081	0	1	04	01	H5521_081_0	3	Preferred Generic	4	01	1	2	1	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	081	0	1	04	01	H5521_081_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	081	0	1	04	01	H5521_081_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_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	081	0	1	04	01	H5521_081_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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			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								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 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								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			0.50	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	29						1.00	29												29						29						29		29								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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	085	0	1	04	01	H5521_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	085	0	1	04	01	H5521_085_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_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	10.00					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		
H5521	085	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	085	0	1	04	01	H5521_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												
H5521	085	0	1	04	01	H5521_085_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	086	0	1	04	01	H5521_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								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	086	0	1	04	01	H5521_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								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	086	0	1	04	01	H5521_086_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	086	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_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												
H5521	086	0	1	04	01	H5521_086_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	087	0	1	04	01	H5521_087_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	087	0	1	04	01	H5521_087_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_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	10.00					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		
H5521	087	0	1	04	01	H5521_087_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_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	087	0	1	04	01	H5521_087_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	088	0	1	04	01	H5521_088_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	088	0	1	04	01	H5521_088_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_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	10.00					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		
H5521	088	0	1	04	01	H5521_088_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_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	088	0	1	04	01	H5521_088_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	089	0	1	04	01	H5521_089_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	089	0	1	04	01	H5521_089_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_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	10.00					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		
H5521	089	0	1	04	01	H5521_089_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_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	089	0	1	04	01	H5521_089_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	090	0	1	04	01	H5521_090_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	090	0	1	04	01	H5521_090_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_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	10.00					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		
H5521	090	0	1	04	01	H5521_090_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_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	090	0	1	04	01	H5521_090_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	091	0	1	04	01	H5521_091_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	091	0	1	04	01	H5521_091_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_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	10.00					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		
H5521	091	0	1	04	01	H5521_091_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_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	091	0	1	04	01	H5521_091_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	092	0	1	04	01	H5521_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								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	092	0	1	04	01	H5521_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								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	092	0	1	04	01	H5521_092_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	092	0	1	04	01	H5521_092_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	092	0	1	04	01	H5521_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	092	0	1	04	01	H5521_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	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	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	094	0	1	04	01	H5521_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								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	094	0	1	04	01	H5521_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								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	094	0	1	04	01	H5521_094_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	094	0	1	04	01	H5521_094_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	094	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	094	0	1	04	01	H5521_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												
H5521	094	0	1	04	01	H5521_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												
H5521	095	0	1	04	01	H5521_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								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	095	0	1	04	01	H5521_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								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	095	0	1	04	01	H5521_095_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	095	0	1	04	01	H5521_095_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	095	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	095	0	1	04	01	H5521_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												
H5521	095	0	1	04	01	H5521_095_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	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								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	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								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	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	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	100	0	1	04	01	H5521_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								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	100	0	1	04	01	H5521_100_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_100_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	100	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_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												
H5521	100	0	1	04	01	H5521_100_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	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								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	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								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	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	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						1.00	31												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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	103	0	1	04	01	H5521_103_0	3	Preferred Generic	4	01	1	2	1	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	103	0	1	04	01	H5521_103_0	3	Preferred Generic	4	01	1	2	1	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	103	0	1	04	01	H5521_103_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	103	0	1	04	01	H5521_103_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	103	0	1	04	01	H5521_103_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	103	0	1	04	01	H5521_103_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	103	0	1	04	01	H5521_103_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	104	0	1	04	01	H5521_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								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	104	0	1	04	01	H5521_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								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	104	0	1	04	01	H5521_104_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	104	0	1	04	01	H5521_104_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	104	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	104	0	1	04	01	H5521_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												
H5521	104	0	1	04	01	H5521_104_0	3	Specialty Tier	4	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												
H5521	105	0	1	04	01	H5521_105_0	3	Preferred Generic	4	01	1	2	1	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	105	0	1	04	01	H5521_105_0	3	Preferred Generic	4	01	1	2	1	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	105	0	1	04	01	H5521_105_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	105	0	1	04	01	H5521_105_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	105	0	1	04	01	H5521_105_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	105	0	1	04	01	H5521_105_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	105	0	1	04	01	H5521_105_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	107	0	1	04	01	H5521_107_0	3	Preferred Generic	4	01	1	2	1	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	107	0	1	04	01	H5521_107_0	3	Preferred Generic	4	01	1	2	1	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	107	0	1	04	01	H5521_107_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	107	0	1	04	01	H5521_107_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	107	0	1	04	01	H5521_107_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	107	0	1	04	01	H5521_107_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	107	0	1	04	01	H5521_107_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	108	0	1	04	01	H5521_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								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	108	0	1	04	01	H5521_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								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	108	0	1	04	01	H5521_108_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	108	0	1	04	01	H5521_108_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	108	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	108	0	1	04	01	H5521_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												
H5521	108	0	1	04	01	H5521_108_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	109	0	1	04	01	H5521_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								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	109	0	1	04	01	H5521_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								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	109	0	1	04	01	H5521_109_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	109	0	1	04	01	H5521_109_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	109	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	109	0	1	04	01	H5521_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												
H5521	109	0	1	04	01	H5521_109_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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	114	0	1	04	01	H5521_114_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	114	0	1	04	01	H5521_114_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	114	0	1	04	01	H5521_114_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	114	0	1	04	01	H5521_114_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	10.00					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		
H5521	114	0	1	04	01	H5521_114_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	114	0	1	04	01	H5521_114_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	114	0	1	04	01	H5521_114_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	115	0	1	04	01	H5521_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	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	115	0	1	04	01	H5521_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	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	115	0	1	04	01	H5521_115_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	115	0	1	04	01	H5521_115_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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	115	0	1	04	01	H5521_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																			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	115	0	1	04	01	H5521_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			100.00		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	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	116	0	1	04	01	H5521_116_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	116	0	1	04	01	H5521_116_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_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	10.00					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		
H5521	116	0	1	04	01	H5521_116_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_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	116	0	1	04	01	H5521_116_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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	118	0	1	04	01	H5521_118_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_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	10.00					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		
H5521	118	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_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												
H5521	118	0	1	04	01	H5521_118_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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	120	0	1	04	01	H5521_120_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_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	10.00					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		
H5521	120	0	1	04	01	H5521_120_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_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	120	0	1	04	01	H5521_120_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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	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	122	0	1	04	01	H5521_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								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	122	0	1	04	01	H5521_122_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	122	0	1	04	01	H5521_122_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	122	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	122	0	1	04	01	H5521_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												
H5521	122	0	1	04	01	H5521_122_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	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								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	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								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	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	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		
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								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 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								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			0.50	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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	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	125	0	1	04	01	H5521_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								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	125	0	1	04	01	H5521_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	125	0	1	04	01	H5521_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	125	0	1	04	01	H5521_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	125	0	1	04	01	H5521_125_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	125	0	1	04	01	H5521_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												
H5521	126	0	1	04	01	H5521_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								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	126	0	1	04	01	H5521_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								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	126	0	1	04	01	H5521_126_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	126	0	1	04	01	H5521_126_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	126	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	126	0	1	04	01	H5521_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												
H5521	126	0	1	04	01	H5521_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												
H5521	127	0	1	04	01	H5521_127_0	3	Preferred Generic	4	01	1	2	1	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	127	0	1	04	01	H5521_127_0	3	Preferred Generic	4	01	1	2	1	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	127	0	1	04	01	H5521_127_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	127	0	1	04	01	H5521_127_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_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	127	0	1	04	01	H5521_127_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	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								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	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								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	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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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	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								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	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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	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	33						1.00	33												33						33						33		33								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	0.00																			7.00	14.00	0.00																	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	0.00																			7.00	14.00	0.00																	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	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	134	0	1	04	01	H5521_134_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_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	10.00					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		
H5521	134	0	1	04	01	H5521_134_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_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	134	0	1	04	01	H5521_134_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	139	0	1	04	01	H5521_139_0	3	Preferred Generic	4	01	1	2	1	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	139	0	1	04	01	H5521_139_0	3	Preferred Generic	4	01	1	2	1	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	139	0	1	04	01	H5521_139_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	139	0	1	04	01	H5521_139_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	139	0	1	04	01	H5521_139_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	139	0	1	04	01	H5521_139_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	139	0	1	04	01	H5521_139_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	140	0	1	04	01	H5521_140_0	3	Preferred Generic	4	01	1	2	1	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	140	0	1	04	01	H5521_140_0	3	Preferred Generic	4	01	1	2	1	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	140	0	1	04	01	H5521_140_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	140	0	1	04	01	H5521_140_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	140	0	1	04	01	H5521_140_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	140	0	1	04	01	H5521_140_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	140	0	1	04	01	H5521_140_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	141	0	1	04	01	H5521_141_0	3	Preferred Generic	4	01	1	2	1	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	141	0	1	04	01	H5521_141_0	3	Preferred Generic	4	01	1	2	1	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	141	0	1	04	01	H5521_141_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	141	0	1	04	01	H5521_141_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	141	0	1	04	01	H5521_141_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	141	0	1	04	01	H5521_141_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	141	0	1	04	01	H5521_141_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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	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	143	0	1	04	01	H5521_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								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	143	0	1	04	01	H5521_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	143	0	1	04	01	H5521_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	143	0	1	04	01	H5521_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	143	0	1	04	01	H5521_143_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	143	0	1	04	01	H5521_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												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	31						1.00	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	145	0	1	04	01	H5521_145_0	3	Preferred Generic	4	01	1	2	1	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	145	0	1	04	01	H5521_145_0	3	Preferred Generic	4	01	1	2	1	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	145	0	1	04	01	H5521_145_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	145	0	1	04	01	H5521_145_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	145	0	1	04	01	H5521_145_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	145	0	1	04	01	H5521_145_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	145	0	1	04	01	H5521_145_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	146	0	1	04	01	H5521_146_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	146	0	1	04	01	H5521_146_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	146	0	1	04	01	H5521_146_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	146	0	1	04	01	H5521_146_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	10.00					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		
H5521	146	0	1	04	01	H5521_146_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	146	0	1	04	01	H5521_146_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	146	0	1	04	01	H5521_146_0	3	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												
H5521	147	0	1	04	01	H5521_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								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	147	0	1	04	01	H5521_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								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	147	0	1	04	01	H5521_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	147	0	1	04	01	H5521_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	147	0	1	04	01	H5521_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	147	0	1	04	01	H5521_147_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	147	0	1	04	01	H5521_147_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	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								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	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								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	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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	149	0	1	04	01	H5521_149_0	3	Preferred Generic	4	01	1	2	1	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	149	0	1	04	01	H5521_149_0	3	Preferred Generic	4	01	1	2	1	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	149	0	1	04	01	H5521_149_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	149	0	1	04	01	H5521_149_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	149	0	1	04	01	H5521_149_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	149	0	1	04	01	H5521_149_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	149	0	1	04	01	H5521_149_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	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								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	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								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	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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	31						1.00	31												31						31						31		31								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								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	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								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	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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	33						1.00	33												33						33						33		33								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								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	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								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	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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	31						1.00	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	154	0	1	04	01	H5521_154_0	3	Preferred Generic	4	01	1	2	1	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	154	0	1	04	01	H5521_154_0	3	Preferred Generic	4	01	1	2	1	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	154	0	1	04	01	H5521_154_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	154	0	1	04	01	H5521_154_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	154	0	1	04	01	H5521_154_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	154	0	1	04	01	H5521_154_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	154	0	1	04	01	H5521_154_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	156	0	1	04	01	H5521_156_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	156	0	1	04	01	H5521_156_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	156	0	1	04	01	H5521_156_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	156	0	1	04	01	H5521_156_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	10.00					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		
H5521	156	0	1	04	01	H5521_156_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	156	0	1	04	01	H5521_156_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	156	0	1	04	01	H5521_156_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	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								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	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								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	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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	29						1.00	29												29						29						29		29								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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	167	0	1	04	01	H5521_167_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	167	0	1	04	01	H5521_167_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	167	0	1	04	01	H5521_167_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	167	0	1	04	01	H5521_167_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	10.00					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		
H5521	167	0	1	04	01	H5521_167_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	167	0	1	04	01	H5521_167_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	167	0	1	04	01	H5521_167_0	3	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												
H5521	168	0	1	04	01	H5521_168_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	168	0	1	04	01	H5521_168_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	168	0	1	04	01	H5521_168_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	168	0	1	04	01	H5521_168_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	10.00					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		
H5521	168	0	1	04	01	H5521_168_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	168	0	1	04	01	H5521_168_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	168	0	1	04	01	H5521_168_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	169	0	1	04	01	H5521_169_0	3	Preferred Generic	4	01	1	2	1	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	169	0	1	04	01	H5521_169_0	3	Preferred Generic	4	01	1	2	1	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	169	0	1	04	01	H5521_169_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	169	0	1	04	01	H5521_169_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	169	0	1	04	01	H5521_169_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	169	0	1	04	01	H5521_169_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	169	0	1	04	01	H5521_169_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	170	0	1	04	01	H5521_170_0	3	Preferred Generic	4	01	1	2	1	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	170	0	1	04	01	H5521_170_0	3	Preferred Generic	4	01	1	2	1	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	170	0	1	04	01	H5521_170_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	170	0	1	04	01	H5521_170_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	170	0	1	04	01	H5521_170_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	170	0	1	04	01	H5521_170_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	170	0	1	04	01	H5521_170_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	171	0	1	04	01	H5521_171_0	3	Preferred Generic	4	01	1	2	1	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	171	0	1	04	01	H5521_171_0	3	Preferred Generic	4	01	1	2	1	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	171	0	1	04	01	H5521_171_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	171	0	1	04	01	H5521_171_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	171	0	1	04	01	H5521_171_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	171	0	1	04	01	H5521_171_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	171	0	1	04	01	H5521_171_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	177	0	1	04	01	H5521_177_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	177	0	1	04	01	H5521_177_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	177	0	1	04	01	H5521_177_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	177	0	1	04	01	H5521_177_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	10.00					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		
H5521	177	0	1	04	01	H5521_177_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	177	0	1	04	01	H5521_177_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	177	0	1	04	01	H5521_177_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	178	0	1	04	01	H5521_178_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	178	0	1	04	01	H5521_178_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	178	0	1	04	01	H5521_178_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	178	0	1	04	01	H5521_178_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	10.00					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		
H5521	178	0	1	04	01	H5521_178_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	178	0	1	04	01	H5521_178_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	178	0	1	04	01	H5521_178_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	183	0	1	04	01	H5521_183_0	3	Preferred Generic	4	01	1	2	1	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	183	0	1	04	01	H5521_183_0	3	Preferred Generic	4	01	1	2	1	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	183	0	1	04	01	H5521_183_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	183	0	1	04	01	H5521_183_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	183	0	1	04	01	H5521_183_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	183	0	1	04	01	H5521_183_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	183	0	1	04	01	H5521_183_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	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								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	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								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	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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	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	33						1.00	33												33						33						33		33								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								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	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								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	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	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	29						1.00	29												29						29						29		29								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								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	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								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	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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	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	33						1.00	33												33						33						33		33								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								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	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								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	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	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						1.00	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	190	0	1	04	01	H5521_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								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	190	0	1	04	01	H5521_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								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	190	0	1	04	01	H5521_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	190	0	1	04	01	H5521_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	190	0	1	04	01	H5521_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	190	0	1	04	01	H5521_190_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	190	0	1	04	01	H5521_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												
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								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	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								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	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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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												
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								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				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		
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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	Preferred Generic	4	01	1	2	1	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	195	0	1	04	01	H5521_195_0	3	Preferred Generic	4	01	1	2	1	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	195	0	1	04	01	H5521_195_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	195	0	1	04	01	H5521_195_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	195	0	1	04	01	H5521_195_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	195	0	1	04	01	H5521_195_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	195	0	1	04	01	H5521_195_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	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								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	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								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	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	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	29						1.00	29												29						29						29		29								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								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	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								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	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	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						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	199	0	1	04	01	H5521_199_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	199	0	1	04	01	H5521_199_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	199	0	1	04	01	H5521_199_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	199	0	1	04	01	H5521_199_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	10.00					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		
H5521	199	0	1	04	01	H5521_199_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	199	0	1	04	01	H5521_199_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	199	0	1	04	01	H5521_199_0	3	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												
H5521	200	0	1	04	01	H5521_200_0	3	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	200	0	1	04	01	H5521_200_0	3	Generic	3	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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	200	0	1	04	01	H5521_200_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	200	0	1	04	01	H5521_200_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	200	0	1	04	01	H5521_200_0	3	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												
H5521	201	0	1	04	01	H5521_201_0	3	Preferred Generic	4	01	1	2	1	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	201	0	1	04	01	H5521_201_0	3	Preferred Generic	4	01	1	2	1	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	201	0	1	04	01	H5521_201_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	201	0	1	04	01	H5521_201_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	201	0	1	04	01	H5521_201_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	201	0	1	04	01	H5521_201_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	201	0	1	04	01	H5521_201_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	202	0	1	04	01	H5521_202_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	202	0	1	04	01	H5521_202_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	202	0	1	04	01	H5521_202_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	202	0	1	04	01	H5521_202_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	10.00					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		
H5521	202	0	1	04	01	H5521_202_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	202	0	1	04	01	H5521_202_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	202	0	1	04	01	H5521_202_0	3	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												
H5521	203	0	1	04	01	H5521_203_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	203	0	1	04	01	H5521_203_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	203	0	1	04	01	H5521_203_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	203	0	1	04	01	H5521_203_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	10.00					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		
H5521	203	0	1	04	01	H5521_203_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	203	0	1	04	01	H5521_203_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	203	0	1	04	01	H5521_203_0	3	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												
H5521	204	0	1	04	01	H5521_204_0	3	Preferred Generic	4	01	1	2	1	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	204	0	1	04	01	H5521_204_0	3	Preferred Generic	4	01	1	2	1	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	204	0	1	04	01	H5521_204_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	204	0	1	04	01	H5521_204_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	204	0	1	04	01	H5521_204_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	204	0	1	04	01	H5521_204_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	204	0	1	04	01	H5521_204_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	205	0	1	04	01	H5521_205_0	3	Preferred Generic	4	01	1	2	1	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	205	0	1	04	01	H5521_205_0	3	Preferred Generic	4	01	1	2	1	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	205	0	1	04	01	H5521_205_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	205	0	1	04	01	H5521_205_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	205	0	1	04	01	H5521_205_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	205	0	1	04	01	H5521_205_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	205	0	1	04	01	H5521_205_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	206	0	1	04	01	H5521_206_0	3	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	206	0	1	04	01	H5521_206_0	3	Generic	3	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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	206	0	1	04	01	H5521_206_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	206	0	1	04	01	H5521_206_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	206	0	1	04	01	H5521_206_0	3	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												
H5521	207	0	1	04	01	H5521_207_0	3	Preferred Generic	4	01	1	2	1	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	207	0	1	04	01	H5521_207_0	3	Preferred Generic	4	01	1	2	1	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	207	0	1	04	01	H5521_207_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	207	0	1	04	01	H5521_207_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	207	0	1	04	01	H5521_207_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	207	0	1	04	01	H5521_207_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	207	0	1	04	01	H5521_207_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	208	0	1	04	01	H5521_208_0	3	Preferred Generic	4	01	1	2	1	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	208	0	1	04	01	H5521_208_0	3	Preferred Generic	4	01	1	2	1	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	208	0	1	04	01	H5521_208_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	208	0	1	04	01	H5521_208_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	208	0	1	04	01	H5521_208_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	208	0	1	04	01	H5521_208_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	208	0	1	04	01	H5521_208_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	211	0	1	04	01	H5521_211_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	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	211	0	1	04	01	H5521_211_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	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	211	0	1	04	01	H5521_211_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	10.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	211	0	1	04	01	H5521_211_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	10.00					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		
H5521	211	0	1	04	01	H5521_211_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	211	0	1	04	01	H5521_211_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	211	0	1	04	01	H5521_211_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	212	0	1	04	01	H5521_212_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	212	0	1	04	01	H5521_212_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	212	0	1	04	01	H5521_212_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	212	0	1	04	01	H5521_212_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	10.00					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		
H5521	212	0	1	04	01	H5521_212_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	212	0	1	04	01	H5521_212_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	212	0	1	04	01	H5521_212_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	213	0	1	04	01	H5521_213_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	213	0	1	04	01	H5521_213_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	213	0	1	04	01	H5521_213_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	213	0	1	04	01	H5521_213_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	10.00					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		
H5521	213	0	1	04	01	H5521_213_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	213	0	1	04	01	H5521_213_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	213	0	1	04	01	H5521_213_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	214	0	1	04	01	H5521_214_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	214	0	1	04	01	H5521_214_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	214	0	1	04	01	H5521_214_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	214	0	1	04	01	H5521_214_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	10.00					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		
H5521	214	0	1	04	01	H5521_214_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	214	0	1	04	01	H5521_214_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	214	0	1	04	01	H5521_214_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	215	0	1	04	01	H5521_215_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	215	0	1	04	01	H5521_215_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	215	0	1	04	01	H5521_215_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	215	0	1	04	01	H5521_215_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	10.00					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		
H5521	215	0	1	04	01	H5521_215_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	215	0	1	04	01	H5521_215_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	215	0	1	04	01	H5521_215_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	216	0	1	04	01	H5521_216_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	216	0	1	04	01	H5521_216_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	216	0	1	04	01	H5521_216_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	216	0	1	04	01	H5521_216_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	10.00					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		
H5521	216	0	1	04	01	H5521_216_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	216	0	1	04	01	H5521_216_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	216	0	1	04	01	H5521_216_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	217	0	1	04	01	H5521_217_0	3	Preferred Generic	4	01	1	2	1	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	217	0	1	04	01	H5521_217_0	3	Preferred Generic	4	01	1	2	1	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	217	0	1	04	01	H5521_217_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	217	0	1	04	01	H5521_217_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	217	0	1	04	01	H5521_217_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	217	0	1	04	01	H5521_217_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	217	0	1	04	01	H5521_217_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	218	0	1	04	01	H5521_218_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	218	0	1	04	01	H5521_218_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	218	0	1	04	01	H5521_218_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	218	0	1	04	01	H5521_218_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	10.00					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		
H5521	218	0	1	04	01	H5521_218_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	218	0	1	04	01	H5521_218_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	218	0	1	04	01	H5521_218_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	219	0	1	04	01	H5521_219_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	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	219	0	1	04	01	H5521_219_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	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	219	0	1	04	01	H5521_219_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	10.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	219	0	1	04	01	H5521_219_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	10.00					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		
H5521	219	0	1	04	01	H5521_219_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	219	0	1	04	01	H5521_219_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	219	0	1	04	01	H5521_219_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	220	0	1	04	01	H5521_220_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	220	0	1	04	01	H5521_220_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	220	0	1	04	01	H5521_220_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	220	0	1	04	01	H5521_220_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	10.00					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		
H5521	220	0	1	04	01	H5521_220_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	220	0	1	04	01	H5521_220_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	220	0	1	04	01	H5521_220_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	221	0	1	04	01	H5521_221_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	221	0	1	04	01	H5521_221_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	221	0	1	04	01	H5521_221_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	221	0	1	04	01	H5521_221_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	10.00					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		
H5521	221	0	1	04	01	H5521_221_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	221	0	1	04	01	H5521_221_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	221	0	1	04	01	H5521_221_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	222	0	1	04	01	H5521_222_0	3	Preferred Generic	4	01	1	2	1	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	222	0	1	04	01	H5521_222_0	3	Preferred Generic	4	01	1	2	1	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	222	0	1	04	01	H5521_222_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	222	0	1	04	01	H5521_222_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	222	0	1	04	01	H5521_222_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	222	0	1	04	01	H5521_222_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	222	0	1	04	01	H5521_222_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	223	0	1	04	01	H5521_223_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	223	0	1	04	01	H5521_223_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	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	223	0	1	04	01	H5521_223_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	223	0	1	04	01	H5521_223_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	10.00					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		
H5521	223	0	1	04	01	H5521_223_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	223	0	1	04	01	H5521_223_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	223	0	1	04	01	H5521_223_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	224	0	1	04	01	H5521_224_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	224	0	1	04	01	H5521_224_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	224	0	1	04	01	H5521_224_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	224	0	1	04	01	H5521_224_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	10.00					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		
H5521	224	0	1	04	01	H5521_224_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	224	0	1	04	01	H5521_224_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	224	0	1	04	01	H5521_224_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	225	0	1	04	01	H5521_225_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	225	0	1	04	01	H5521_225_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	225	0	1	04	01	H5521_225_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	225	0	1	04	01	H5521_225_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	10.00					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		
H5521	225	0	1	04	01	H5521_225_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	225	0	1	04	01	H5521_225_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	225	0	1	04	01	H5521_225_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	226	0	1	04	01	H5521_226_0	3	Preferred Generic	4	01	1	2	1	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	226	0	1	04	01	H5521_226_0	3	Preferred Generic	4	01	1	2	1	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	226	0	1	04	01	H5521_226_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	226	0	1	04	01	H5521_226_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	226	0	1	04	01	H5521_226_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	226	0	1	04	01	H5521_226_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	226	0	1	04	01	H5521_226_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	227	0	1	04	01	H5521_227_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	227	0	1	04	01	H5521_227_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	227	0	1	04	01	H5521_227_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	227	0	1	04	01	H5521_227_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	10.00					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		
H5521	227	0	1	04	01	H5521_227_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	227	0	1	04	01	H5521_227_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	227	0	1	04	01	H5521_227_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	228	0	1	04	01	H5521_228_0	3	Preferred Generic	4	01	1	2	1	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	228	0	1	04	01	H5521_228_0	3	Preferred Generic	4	01	1	2	1	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	228	0	1	04	01	H5521_228_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	228	0	1	04	01	H5521_228_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	228	0	1	04	01	H5521_228_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	228	0	1	04	01	H5521_228_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	228	0	1	04	01	H5521_228_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	230	0	1	04	01	H5521_230_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	230	0	1	04	01	H5521_230_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	230	0	1	04	01	H5521_230_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	230	0	1	04	01	H5521_230_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	10.00					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		
H5521	230	0	1	04	01	H5521_230_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	230	0	1	04	01	H5521_230_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	230	0	1	04	01	H5521_230_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	231	0	1	04	01	H5521_231_0	3	Preferred Generic	4	01	1	2	1	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	231	0	1	04	01	H5521_231_0	3	Preferred Generic	4	01	1	2	1	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	231	0	1	04	01	H5521_231_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	231	0	1	04	01	H5521_231_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	231	0	1	04	01	H5521_231_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	231	0	1	04	01	H5521_231_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	231	0	1	04	01	H5521_231_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	232	0	1	04	01	H5521_232_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	232	0	1	04	01	H5521_232_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	232	0	1	04	01	H5521_232_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	232	0	1	04	01	H5521_232_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	10.00					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		
H5521	232	0	1	04	01	H5521_232_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	232	0	1	04	01	H5521_232_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	232	0	1	04	01	H5521_232_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	233	0	1	04	01	H5521_233_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	233	0	1	04	01	H5521_233_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	233	0	1	04	01	H5521_233_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	233	0	1	04	01	H5521_233_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	10.00					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		
H5521	233	0	1	04	01	H5521_233_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	233	0	1	04	01	H5521_233_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	233	0	1	04	01	H5521_233_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	234	0	1	04	01	H5521_234_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	234	0	1	04	01	H5521_234_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	234	0	1	04	01	H5521_234_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	234	0	1	04	01	H5521_234_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	10.00					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		
H5521	234	0	1	04	01	H5521_234_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	234	0	1	04	01	H5521_234_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	234	0	1	04	01	H5521_234_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	236	0	1	04	01	H5521_236_0	3	Preferred Generic	4	01	1	2	1	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	236	0	1	04	01	H5521_236_0	3	Preferred Generic	4	01	1	2	1	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	236	0	1	04	01	H5521_236_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	236	0	1	04	01	H5521_236_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	236	0	1	04	01	H5521_236_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	236	0	1	04	01	H5521_236_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	236	0	1	04	01	H5521_236_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	237	0	1	04	01	H5521_237_0	3	Preferred Generic	4	01	1	2	1	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	237	0	1	04	01	H5521_237_0	3	Preferred Generic	4	01	1	2	1	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	237	0	1	04	01	H5521_237_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	237	0	1	04	01	H5521_237_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	237	0	1	04	01	H5521_237_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	237	0	1	04	01	H5521_237_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	237	0	1	04	01	H5521_237_0	3	Specialty Tier	4	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												
H5521	239	0	1	04	01	H5521_239_0	3	Preferred Generic	4	01	1	2	1	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	239	0	1	04	01	H5521_239_0	3	Preferred Generic	4	01	1	2	1	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	239	0	1	04	01	H5521_239_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	239	0	1	04	01	H5521_239_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	239	0	1	04	01	H5521_239_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	239	0	1	04	01	H5521_239_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	239	0	1	04	01	H5521_239_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	240	0	1	04	01	H5521_240_0	3	Preferred Generic	4	01	1	2	1	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	240	0	1	04	01	H5521_240_0	3	Preferred Generic	4	01	1	2	1	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	240	0	1	04	01	H5521_240_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	240	0	1	04	01	H5521_240_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	240	0	1	04	01	H5521_240_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	240	0	1	04	01	H5521_240_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	240	0	1	04	01	H5521_240_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	242	0	1	04	01	H5521_242_0	3	Preferred Generic	4	01	1	2	1	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	242	0	1	04	01	H5521_242_0	3	Preferred Generic	4	01	1	2	1	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	242	0	1	04	01	H5521_242_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	242	0	1	04	01	H5521_242_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	242	0	1	04	01	H5521_242_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	242	0	1	04	01	H5521_242_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	242	0	1	04	01	H5521_242_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	243	0	1	04	01	H5521_243_0	3	Preferred Generic	4	01	1	2	1	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	243	0	1	04	01	H5521_243_0	3	Preferred Generic	4	01	1	2	1	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	243	0	1	04	01	H5521_243_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	243	0	1	04	01	H5521_243_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	243	0	1	04	01	H5521_243_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	243	0	1	04	01	H5521_243_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	243	0	1	04	01	H5521_243_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	244	0	1	04	01	H5521_244_0	3	Preferred Generic	4	01	1	2	1	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	244	0	1	04	01	H5521_244_0	3	Preferred Generic	4	01	1	2	1	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	244	0	1	04	01	H5521_244_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	244	0	1	04	01	H5521_244_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	244	0	1	04	01	H5521_244_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	244	0	1	04	01	H5521_244_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	244	0	1	04	01	H5521_244_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	245	0	1	04	01	H5521_245_0	3	Preferred Generic	4	01	1	2	1	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	245	0	1	04	01	H5521_245_0	3	Preferred Generic	4	01	1	2	1	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	245	0	1	04	01	H5521_245_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	245	0	1	04	01	H5521_245_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	245	0	1	04	01	H5521_245_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	245	0	1	04	01	H5521_245_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	245	0	1	04	01	H5521_245_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	246	0	1	04	01	H5521_246_0	3	Preferred Generic	4	01	1	2	1	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	246	0	1	04	01	H5521_246_0	3	Preferred Generic	4	01	1	2	1	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	246	0	1	04	01	H5521_246_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	246	0	1	04	01	H5521_246_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	246	0	1	04	01	H5521_246_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	246	0	1	04	01	H5521_246_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	246	0	1	04	01	H5521_246_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	247	0	1	04	01	H5521_247_0	3	Preferred Generic	4	01	1	2	1	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	247	0	1	04	01	H5521_247_0	3	Preferred Generic	4	01	1	2	1	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	247	0	1	04	01	H5521_247_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	247	0	1	04	01	H5521_247_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	247	0	1	04	01	H5521_247_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	247	0	1	04	01	H5521_247_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	247	0	1	04	01	H5521_247_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	248	0	1	04	01	H5521_248_0	3	Preferred Generic	4	01	1	2	1	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	248	0	1	04	01	H5521_248_0	3	Preferred Generic	4	01	1	2	1	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	248	0	1	04	01	H5521_248_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	248	0	1	04	01	H5521_248_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	248	0	1	04	01	H5521_248_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	248	0	1	04	01	H5521_248_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	248	0	1	04	01	H5521_248_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	249	0	1	04	01	H5521_249_0	3	Preferred Generic	4	01	1	2	1	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	249	0	1	04	01	H5521_249_0	3	Preferred Generic	4	01	1	2	1	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	249	0	1	04	01	H5521_249_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	249	0	1	04	01	H5521_249_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	249	0	1	04	01	H5521_249_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	249	0	1	04	01	H5521_249_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	249	0	1	04	01	H5521_249_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	250	0	1	04	01	H5521_250_0	3	Preferred Generic	4	01	1	2	1	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	250	0	1	04	01	H5521_250_0	3	Preferred Generic	4	01	1	2	1	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	250	0	1	04	01	H5521_250_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	250	0	1	04	01	H5521_250_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	250	0	1	04	01	H5521_250_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	250	0	1	04	01	H5521_250_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	250	0	1	04	01	H5521_250_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	251	0	1	04	01	H5521_251_0	3	Preferred Generic	4	01	1	2	1	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	251	0	1	04	01	H5521_251_0	3	Preferred Generic	4	01	1	2	1	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	251	0	1	04	01	H5521_251_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	251	0	1	04	01	H5521_251_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	251	0	1	04	01	H5521_251_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	251	0	1	04	01	H5521_251_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	251	0	1	04	01	H5521_251_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	252	0	1	04	01	H5521_252_0	3	Preferred Generic	4	01	1	2	1	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	252	0	1	04	01	H5521_252_0	3	Preferred Generic	4	01	1	2	1	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	252	0	1	04	01	H5521_252_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	252	0	1	04	01	H5521_252_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	252	0	1	04	01	H5521_252_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	252	0	1	04	01	H5521_252_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	252	0	1	04	01	H5521_252_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	253	0	1	04	01	H5521_253_0	3	Preferred Generic	4	01	1	2	1	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	253	0	1	04	01	H5521_253_0	3	Preferred Generic	4	01	1	2	1	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	253	0	1	04	01	H5521_253_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	253	0	1	04	01	H5521_253_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	253	0	1	04	01	H5521_253_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	253	0	1	04	01	H5521_253_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	253	0	1	04	01	H5521_253_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	254	0	1	04	01	H5521_254_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	254	0	1	04	01	H5521_254_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	254	0	1	04	01	H5521_254_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	254	0	1	04	01	H5521_254_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	10.00					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		
H5521	254	0	1	04	01	H5521_254_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	254	0	1	04	01	H5521_254_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	254	0	1	04	01	H5521_254_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	257	0	1	04	01	H5521_257_0	3	Preferred Generic	4	01	1	2	1	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	257	0	1	04	01	H5521_257_0	3	Preferred Generic	4	01	1	2	1	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	257	0	1	04	01	H5521_257_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	257	0	1	04	01	H5521_257_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	257	0	1	04	01	H5521_257_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	257	0	1	04	01	H5521_257_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	257	0	1	04	01	H5521_257_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	258	0	1	04	01	H5521_258_0	3	Preferred Generic	4	01	1	2	1	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	258	0	1	04	01	H5521_258_0	3	Preferred Generic	4	01	1	2	1	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	258	0	1	04	01	H5521_258_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5521	258	0	1	04	01	H5521_258_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5521	258	0	1	04	01	H5521_258_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	258	0	1	04	01	H5521_258_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	258	0	1	04	01	H5521_258_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	259	0	1	04	01	H5521_259_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	259	0	1	04	01	H5521_259_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	259	0	1	04	01	H5521_259_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	259	0	1	04	01	H5521_259_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	10.00					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		
H5521	259	0	1	04	01	H5521_259_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	259	0	1	04	01	H5521_259_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	259	0	1	04	01	H5521_259_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	260	0	1	04	01	H5521_260_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	260	0	1	04	01	H5521_260_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	260	0	1	04	01	H5521_260_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	260	0	1	04	01	H5521_260_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	10.00					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		
H5521	260	0	1	04	01	H5521_260_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	260	0	1	04	01	H5521_260_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	260	0	1	04	01	H5521_260_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	261	0	1	04	01	H5521_261_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	261	0	1	04	01	H5521_261_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	261	0	1	04	01	H5521_261_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	261	0	1	04	01	H5521_261_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	10.00					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		
H5521	261	0	1	04	01	H5521_261_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	261	0	1	04	01	H5521_261_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	261	0	1	04	01	H5521_261_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	262	0	1	04	01	H5521_262_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	262	0	1	04	01	H5521_262_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	262	0	1	04	01	H5521_262_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	262	0	1	04	01	H5521_262_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	10.00					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		
H5521	262	0	1	04	01	H5521_262_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	262	0	1	04	01	H5521_262_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	262	0	1	04	01	H5521_262_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	263	0	1	04	01	H5521_263_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	263	0	1	04	01	H5521_263_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	263	0	1	04	01	H5521_263_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	263	0	1	04	01	H5521_263_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	10.00					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		
H5521	263	0	1	04	01	H5521_263_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	263	0	1	04	01	H5521_263_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	263	0	1	04	01	H5521_263_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	001	0	1	04	01	H5522_001_0	3	Preferred Generic	4	01	1	2	1	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												
H5522	001	0	1	04	01	H5522_001_0	3	Preferred Generic	4	01	1	2	1	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		
H5522	001	0	1	04	01	H5522_001_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5522	001	0	1	04	01	H5522_001_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5522	001	0	1	04	01	H5522_001_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_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	001	0	1	04	01	H5522_001_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	002	0	1	04	01	H5522_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								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												
H5522	002	0	1	04	01	H5522_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								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		
H5522	002	0	1	04	01	H5522_002_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5522	002	0	1	04	01	H5522_002_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5522	002	0	1	04	01	H5522_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	002	0	1	04	01	H5522_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												
H5522	002	0	1	04	01	H5522_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												
H5522	004	0	1	04	01	H5522_004_0	2	Preferred Generic	4	01	1	2	1	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												
H5522	004	0	1	04	01	H5522_004_0	2	Preferred Generic	4	01	1	2	1	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		
H5522	004	0	1	04	01	H5522_004_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5522	004	0	1	04	01	H5522_004_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5522	004	0	1	04	01	H5522_004_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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												
H5522	005	0	1	04	01	H5522_005_0	2	Preferred Generic	4	01	1	2	1	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		
H5522	005	0	1	04	01	H5522_005_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5522	005	0	1	04	01	H5522_005_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5522	005	0	1	04	01	H5522_005_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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												
H5522	013	0	1	04	01	H5522_013_0	2	Preferred Generic	4	01	1	2	1	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		
H5522	013	0	1	04	01	H5522_013_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5522	013	0	1	04	01	H5522_013_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5522	013	0	1	04	01	H5522_013_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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												
H5522	014	0	1	04	01	H5522_014_0	2	Preferred Generic	4	01	1	2	1	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		
H5522	014	0	1	04	01	H5522_014_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5522	014	0	1	04	01	H5522_014_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5522	014	0	1	04	01	H5522_014_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	Preferred Generic	4	01	1	2	1	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												
H5522	017	0	1	04	01	H5522_017_0	2	Preferred Generic	4	01	1	2	1	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		
H5522	017	0	1	04	01	H5522_017_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	017	0	1	04	01	H5522_017_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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												
H5522	018	0	1	04	01	H5522_018_0	2	Preferred Generic	4	01	1	2	1	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												
H5522	018	0	1	04	01	H5522_018_0	2	Preferred Generic	4	01	1	2	1	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		
H5522	018	0	1	04	01	H5522_018_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5522	018	0	1	04	01	H5522_018_0	2	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5522	018	0	1	04	01	H5522_018_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	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	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	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	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												
H5525	005	0	1	04	01	H5525_005_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	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 Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_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					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												
H5525	006	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_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												
H5525	007	0	1	04	01	H5525_007_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												
H5525	007	0	1	04	01	H5525_007_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	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 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	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	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	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	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	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	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	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												
H5525	017	0	1	04	01	H5525_017_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	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 Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_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												
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					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	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					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	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	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	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					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	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					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	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	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	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												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_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												
H5525	024	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_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												
H5525	025	0	1	04	01	H5525_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	025	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	025	0	1	04	01	H5525_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_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												
H5525	026	0	1	04	01	H5525_026_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												
H5525	026	0	1	04	01	H5525_026_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_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												
H5525	027	0	1	04	01	H5525_027_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	5	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				63.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	5	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												
H5525	030	0	1	04	01	H5525_030_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					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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_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												
H5525	032	0	1	04	01	H5525_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												
H5525	032	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	032	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	032	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	032	0	1	04	01	H5525_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												
H5525	033	0	1	04	01	H5525_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					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	033	0	1	04	01	H5525_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	033	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	033	0	1	04	01	H5525_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	033	0	1	04	01	H5525_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												
H5525	034	0	1	04	01	H5525_034_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					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	034	0	1	04	01	H5525_034_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_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												
H5525	035	0	1	04	01	H5525_035_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												
H5525	035	0	1	04	01	H5525_035_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_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												
H5525	036	0	1	04	01	H5525_036_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												
H5525	036	0	1	04	01	H5525_036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	036	0	1	04	01	H5525_036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	036	0	1	04	01	H5525_036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	036	0	1	04	01	H5525_036_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												
H5525	037	0	1	04	01	H5525_037_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												
H5525	037	0	1	04	01	H5525_037_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_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												
H5525	038	0	1	04	01	H5525_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					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	038	0	1	04	01	H5525_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	038	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	038	0	1	04	01	H5525_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	038	0	1	04	01	H5525_038_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	039	0	1	04	01	H5525_039_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												
H5525	039	0	1	04	01	H5525_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_039_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	040	0	1	04	01	H5525_040_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												
H5525	040	0	1	04	01	H5525_040_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	040	0	1	04	01	H5525_040_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	040	0	1	04	01	H5525_040_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	040	0	1	04	01	H5525_040_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	041	0	1	04	01	H5525_041_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												
H5525	041	0	1	04	01	H5525_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_041_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	042	0	1	04	01	H5525_042_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												
H5525	042	0	1	04	01	H5525_042_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_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												
H5526	004	0	1	04	01	H5526_004_0	6	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	6	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	6	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	6	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	6	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	6	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	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					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	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					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	6	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	6	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											80.62	50		50				80.30	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	6	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	7	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	7	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	7	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	7	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	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					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	7	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												
H5533	003	0	1	04	01	H5533_003_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	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							285.00																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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											486.14	33						417.87	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	005	0	1	04	01	H5533_005_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	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							285.00																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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											392.07	33						456.25	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	007	0	1	04	01	H5533_007_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	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							285.00																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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											486.14	33						417.87	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	008	0	1	04	01	H5533_008_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							0.00																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	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		20.00							20.00																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	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		105.00							105.00																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	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							285.00																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	5	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											486.14	33						417.87	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	10	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	003	0	1	01	01	H5549_003_0	10	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	003	0	1	01	01	H5549_003_0	10	Preferred Brand	2	10	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	10	Non-Preferred Brand	2	10	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				71.32	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	10	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	008	0	1	02	01	H5576_008_0	8	Preferred Generic	2	01	1	1	1	1	110		01		110	1	31		90				1	1				31		90	31		31				2.19	25		25																								25		25				0		0			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	008	0	1	02	01	H5576_008_0	8	Generic	2	01	1	1	2	1	110		01		110	1	31		90				1	1				31		90	31		31				7.02	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	008	0	1	02	01	H5576_008_0	8	Preferred Brand	2	10	1	1	3	1	110		01		110	1	31		90				1	1				31		90	31		31				81.92	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	008	0	1	02	01	H5576_008_0	8	Non-Preferred Brand	2	10	1	1	4	1	110		01		110	1	31		90				1	1				31		90	31		31				90.05	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	008	0	1	02	01	H5576_008_0	8	Specialty Tier	2	10	1	1	5	1	010		01		010	1	31											31			31		31				848.26	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_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	017	1	1	02	01	H5576_017_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	017	1	1	02	01	H5576_017_1	11	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	11	Non-Preferred Brand	4	10	1	1	4	1	110		01		100	1	31		90				1	2						90	31		31				105.11	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	11	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				1811.75	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	10	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	10	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	10	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	10	Non-Preferred Brand	4	10	1	1	4	1	110		01		100	1	31		90				1	2						90	31		31				105.11	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	10	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				1811.75	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	10	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	10	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	10	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	10	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	10	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	10	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				2191.19	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	10	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	10	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	10	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	10	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	10	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	10	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				2191.19	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	019	0	1	02	01	H5576_019_0	8	Preferred Generic	2	01	1	1	1	1	110		01		110	1	31		90				1	1				31		90	31		31				2.17	25		25																								25		25				0		0			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	019	0	1	02	01	H5576_019_0	8	Generic	2	01	1	1	2	1	110		01		110	1	31		90				1	1				31		90	31		31				6.73	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	019	0	1	02	01	H5576_019_0	8	Preferred Brand	2	10	1	1	3	1	110		01		110	1	31		90				1	1				31		90	31		31				80.59	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	019	0	1	02	01	H5576_019_0	8	Non-Preferred Brand	2	10	1	1	4	1	110		01		110	1	31		90				1	1				31		90	31		31				88.46	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	019	0	1	02	01	H5576_019_0	8	Specialty Tier	2	10	1	1	5	1	010		01		010	1	31											31			31		31				844.45	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	10	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	6.00		18.00																									6.00		18.00				0.00		0.00				6.00				6.00		0.19				0.19	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	10	Generic	4	01	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	15.00		45.00																											45.00						45.00				15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	10	Preferred Brand	4	10	1	1	3	1	110		01		100	1	31		90				1	2						90	31		31				93.93	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	10	Non-Preferred Brand	4	10	1	1	4	1	110		01		100	1	31		90				1	2						90	31		31				82.80	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	10	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				1142.61	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	10	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	6.00		18.00																									6.00		18.00				0.00		0.00				6.00				6.00		0.19				0.19	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	10	Generic	4	01	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	15.00		45.00																											45.00						45.00				15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	10	Preferred Brand	4	10	1	1	3	1	110		01		100	1	31		90				1	2						90	31		31				93.93	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	10	Non-Preferred Brand	4	10	1	1	4	1	110		01		100	1	31		90				1	2						90	31		31				82.80	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	10	Specialty Tier	4	10	1	1	5	1	010		01			1	31														31		31				1142.61	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				1850.43	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	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	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	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	005	0	1	01	01	H5577_005_0	4	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				2	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, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				2	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, Select Care Drugs										1		3
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	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	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	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	0.00	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												
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	0.00	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		
H5577	008	0	1	02	01	H5577_008_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	008	0	1	02	01	H5577_008_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	008	0	1	02	01	H5577_008_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	1			90				30		31	55.00	110.00	165.00																					110.00																55.00				55.00		1.83						1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_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	008	0	1	02	01	H5577_008_0	4	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	4	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H5577	030	0	1	01	01	H5577_030_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	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, Select Care Drugs												
H5577	030	0	1	01	01	H5577_030_0	4	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	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, Select Care Drugs										1		
H5577	030	0	1	01	01	H5577_030_0	4	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	030	0	1	01	01	H5577_030_0	4	Generic	4	01	1	2	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	030	0	1	01	01	H5577_030_0	4	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	18.00	36.00	54.00																					36.00																18.00				18.00		0.60						0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	030	0	1	01	01	H5577_030_0	4	Non-Preferred Brand	4	10	1	2	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	030	0	1	01	01	H5577_030_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	030	0	1	01	01	H5577_030_0	4	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H5577	030	0	1	01	01	H5577_030_0	4	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H5577	031	0	1	01	01	H5577_031_0	4	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	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	031	0	1	01	01	H5577_031_0	4	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	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	031	0	1	01	01	H5577_031_0	4	Generic	4	01	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	031	0	1	01	01	H5577_031_0	4	Generic	4	01	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5577	031	0	1	01	01	H5577_031_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	031	0	1	01	01	H5577_031_0	4	Non-Preferred Brand	4	10	3	2	4	1	111		01	100		1	30	60	90				2	1			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 Brand, Specialty Tier, Select Care Drugs												
H5577	031	0	1	01	01	H5577_031_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	031	0	1	01	01	H5577_031_0	4	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs												
H5577	031	0	1	01	01	H5577_031_0	4	Select Care Drugs	4	01	1	2	6	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, Select Care Drugs										1		
H5590	004	0	1	01	01	H5590_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								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	7.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	004	0	1	01	01	H5590_004_0	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 Drug, Specialty Tier, Select Care Drugs												
H5590	004	0	1	01	01	H5590_004_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					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 Drug, Specialty Tier, Select Care Drugs												
H5590	004	0	1	01	01	H5590_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					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 Drug, Specialty Tier, Select Care Drugs												
H5590	004	0	1	01	01	H5590_004_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, Select Care Drugs												
H5590	004	0	1	01	01	H5590_004_0	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 Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_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					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 Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	10	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					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 Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_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, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H5590	006	1	1	01	01	H5590_006_1	7	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												
H5590	006	1	1	01	01	H5590_006_1	7	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												
H5590	006	1	1	01	01	H5590_006_1	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	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												
H5590	006	1	1	01	01	H5590_006_1	7	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												
H5590	006	1	1	01	01	H5590_006_1	7	Specialty Tier	3	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, Select Care Drugs												
H5590	006	1	1	01	01	H5590_006_1	7	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												
H5590	006	2	1	01	01	H5590_006_2	7	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												
H5590	006	2	1	01	01	H5590_006_2	7	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												
H5590	006	2	1	01	01	H5590_006_2	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	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												
H5590	006	2	1	01	01	H5590_006_2	7	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												
H5590	006	2	1	01	01	H5590_006_2	7	Specialty Tier	3	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, Select Care Drugs												
H5590	006	2	1	01	01	H5590_006_2	7	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												
H5591	001	0	1	02	01	H5591_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								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	7	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	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					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	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					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	7	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	7	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	7	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	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					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	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					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	7	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	7	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	7	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	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					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	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					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	7	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	7	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	7	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	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					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	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					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	7	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	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	007	0	1	01	01	H5591_007_0	6	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	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	007	0	1	01	01	H5591_007_0	6	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	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	007	0	1	01	01	H5591_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								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	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	33	33	33				600.00	33	33	33				33	33	33															33			33								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	013	0	1	01	01	H5591_013_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	013	0	1	01	01	H5591_013_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	013	0	1	01	01	H5591_013_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	013	0	1	01	01	H5591_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		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	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												
H5594	001	0	1	01	01	H5594_001_0	7	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	7	Preferred Generic	4	11	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	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	7	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	7	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	7	Preferred Generic	4	11	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	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	7	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	65.00		195.00																			65.00		130.00																65.00				65.00		2.17			2.17			2.10	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	7	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	7	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	7	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	7	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	7	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	7	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	7	Preferred Generic	4	11	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	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	7	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	7	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	7	Preferred Generic	4	11	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	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	7	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	7	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	7	Preferred Generic	4	11	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	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	7	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	7	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	7	Preferred Generic	4	11	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	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	7	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	7	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	7	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	7	Preferred Generic	4	11	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	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	7	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	7	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	7	Preferred Generic	4	11	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	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	7	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	7	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	7	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	7	Preferred Generic	4	11	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	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	7	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	7	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	7	Preferred Generic	4	11	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	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	7	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	7	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	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	8	Preferred Generic	4	11	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	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	8	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	8	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	8	Preferred Generic	4	11	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	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	8	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	8	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	4	Preferred Generic	3	01	1	2	1	1	110		10	100		1	30		90				1	2			90					10	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												
H5608	002	0	1	01	01	H5608_002_0	4	Generic	3	01	1	2	2	1	110		10	100		1	30		90				1	2			90					10	31	10.00		20.00																					20.00																	10.00			10.00		.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5608	002	0	1	01	01	H5608_002_0	4	Preferred Brand	3	10	1	1	3	1	110		10	100		1	30		90				1	2			90					10	31				38.81	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	4	Non-Preferred Brand	3	10	1	1	4	1	110		10	100		1	30		90				1	2			90					10	31				45.56	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	4	Specialty Tier	3	11	1	1	5	1	010		10	010		1	30								30							10	31				226.15	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	4	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	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												
H5619	001	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_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												
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	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	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	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	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_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	013	0	1	01	01	H5619_013_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_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	015	0	1	01	01	H5619_015_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_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												
H5619	016	0	1	01	01	H5619_016_0	5	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	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 Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	5	Preferred Generic	4	11	3	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	5	Preferred Generic	4	11	3	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		3
H5619	021	0	1	01	01	H5619_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	021	0	1	01	01	H5619_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_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		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	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 Drug, Specialty Tier												
H5619	023	0	1	01	01	H5619_023_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	023	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	023	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	023	0	1	01	01	H5619_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												
H5619	026	0	1	01	01	H5619_026_0	5	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	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 Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	6	Preferred Generic	4	11	3	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	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	6	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	032	0	1	01	01	H5619_032_0	6	Preferred Generic	4	11	3	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	032	0	1	01	01	H5619_032_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_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		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_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		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_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												
H5619	037	0	1	01	01	H5619_037_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												
H5619	037	0	1	01	01	H5619_037_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_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												
H5619	038	0	1	01	01	H5619_038_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												
H5619	038	0	1	01	01	H5619_038_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_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	039	1	1	01	01	H5619_039_1	5	Preferred Generic	4	11	3	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	039	1	1	01	01	H5619_039_1	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	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		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	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		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_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 Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	5	Preferred Generic	4	11	3	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	039	2	1	01	01	H5619_039_2	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	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		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	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		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_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 Drug, Specialty Tier												
H5619	040	1	1	01	01	H5619_040_1	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												
H5619	040	1	1	01	01	H5619_040_1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	1	1	01	01	H5619_040_1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	1	1	01	01	H5619_040_1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	1	1	01	01	H5619_040_1	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												
H5619	040	2	1	01	01	H5619_040_2	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												
H5619	040	2	1	01	01	H5619_040_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	2	1	01	01	H5619_040_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	2	1	01	01	H5619_040_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	2	1	01	01	H5619_040_2	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												
H5619	040	3	1	01	01	H5619_040_3	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												
H5619	040	3	1	01	01	H5619_040_3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	3	1	01	01	H5619_040_3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	3	1	01	01	H5619_040_3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	3	1	01	01	H5619_040_3	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												
H5619	041	0	1	01	01	H5619_041_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	041	0	1	01	01	H5619_041_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_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	042	1	1	01	01	H5619_042_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					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	042	1	1	01	01	H5619_042_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	042	1	1	01	01	H5619_042_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	042	1	1	01	01	H5619_042_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	042	1	1	01	01	H5619_042_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												
H5619	042	2	1	01	01	H5619_042_2	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	042	2	1	01	01	H5619_042_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	042	2	1	01	01	H5619_042_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	042	2	1	01	01	H5619_042_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	042	2	1	01	01	H5619_042_2	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	044	0	1	01	01	H5619_044_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					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	044	0	1	01	01	H5619_044_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	044	0	1	01	01	H5619_044_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	044	0	1	01	01	H5619_044_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	044	0	1	01	01	H5619_044_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												
H5619	045	0	1	01	01	H5619_045_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	045	0	1	01	01	H5619_045_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	045	0	1	01	01	H5619_045_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	045	0	1	01	01	H5619_045_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	045	0	1	01	01	H5619_045_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	046	0	1	01	01	H5619_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					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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_046_0	5	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												
H5619	046	0	1	01	01	H5619_046_0	5	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	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												
H5619	047	0	1	01	01	H5619_047_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	047	0	1	01	01	H5619_047_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	047	0	1	01	01	H5619_047_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	047	0	1	01	01	H5619_047_0	5	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	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	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	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	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	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	050	0	1	01	01	H5619_050_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_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	051	0	1	01	01	H5619_051_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	051	0	1	01	01	H5619_051_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_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	052	0	1	01	01	H5619_052_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	052	0	1	01	01	H5619_052_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_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	053	0	1	01	01	H5619_053_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	053	0	1	01	01	H5619_053_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_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	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	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	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	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												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	055	0	1	01	01	H5619_055_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, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_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, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	5	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	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_056_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	057	0	1	01	01	H5619_057_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_057_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	059	0	1	01	01	H5619_059_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_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												
H5619	060	0	1	01	01	H5619_060_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_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	061	0	1	01	01	H5619_061_0	5	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	061	0	1	01	01	H5619_061_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	061	0	1	01	01	H5619_061_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	061	0	1	01	01	H5619_061_0	5	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												
H5619	062	0	1	01	01	H5619_062_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	062	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	062	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	062	0	1	01	01	H5619_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												
H5619	063	0	1	01	01	H5619_063_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_063_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	064	0	1	01	01	H5619_064_0	4	Preferred Generic	4	11	3	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	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	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	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	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	065	0	1	01	01	H5619_065_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_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	066	0	1	01	01	H5619_066_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	066	0	1	01	01	H5619_066_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_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												
H5619	067	0	1	01	01	H5619_067_0	5	Preferred Generic	4	11	3	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	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	067	0	1	01	01	H5619_067_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	067	0	1	01	01	H5619_067_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	067	0	1	01	01	H5619_067_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												
H5619	069	0	1	01	01	H5619_069_0	3	Preferred Generic	4	11	3	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	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	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	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	4	Preferred Generic	4	11	3	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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	070	1	1	01	01	H5619_070_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	070	1	1	01	01	H5619_070_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	070	1	1	01	01	H5619_070_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												
H5619	070	2	1	01	01	H5619_070_2	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	070	2	1	01	01	H5619_070_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	070	2	1	01	01	H5619_070_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	070	2	1	01	01	H5619_070_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												
H5619	071	0	1	01	01	H5619_071_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												
H5619	071	0	1	01	01	H5619_071_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_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												
H5619	073	0	1	01	01	H5619_073_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												
H5619	073	0	1	01	01	H5619_073_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	073	0	1	01	01	H5619_073_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	073	0	1	01	01	H5619_073_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	073	0	1	01	01	H5619_073_0	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 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					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	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	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	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												29							29												29						29					29			29								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					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	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	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	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												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	077	0	1	01	01	H5619_077_0	4	Preferred Generic	4	11	3	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	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	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	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	3	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	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	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	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	3	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	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	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	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	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	080	0	1	01	01	H5619_080_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_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	081	0	1	01	01	H5619_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	081	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	081	0	1	01	01	H5619_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	081	0	1	01	01	H5619_081_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	082	0	1	01	01	H5619_082_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	082	0	1	01	01	H5619_082_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	082	0	1	01	01	H5619_082_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	082	0	1	01	01	H5619_082_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	082	0	1	01	01	H5619_082_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	083	0	1	01	01	H5619_083_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												
H5619	083	0	1	01	01	H5619_083_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_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												
H5619	084	0	1	01	01	H5619_084_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												
H5619	084	0	1	01	01	H5619_084_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	084	0	1	01	01	H5619_084_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	084	0	1	01	01	H5619_084_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	084	0	1	01	01	H5619_084_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												
H5619	086	0	1	01	01	H5619_086_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	086	0	1	01	01	H5619_086_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	086	0	1	01	01	H5619_086_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	086	0	1	01	01	H5619_086_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	086	0	1	01	01	H5619_086_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	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					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	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					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	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	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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, 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												29							29												29						29					29			29								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	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												
H5619	088	0	1	01	01	H5619_088_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_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	089	0	1	01	01	H5619_089_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												
H5619	089	0	1	01	01	H5619_089_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_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	090	0	1	01	01	H5619_090_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												
H5619	090	0	1	01	01	H5619_090_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	01	01	H5619_090_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	091	0	1	01	01	H5619_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	01	01	H5619_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	01	01	H5619_091_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	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	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	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	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												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_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												
H5619	094	0	1	01	01	H5619_094_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_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	095	0	1	01	01	H5619_095_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												
H5619	095	0	1	01	01	H5619_095_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	01	01	H5619_095_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	01	01	H5619_095_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	01	01	H5619_095_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												
H5619	097	0	1	01	01	H5619_097_0	4	Preferred Generic	4	11	3	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	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	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	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												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	4	Preferred Generic	4	11	3	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	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	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	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												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	100	0	1	01	01	H5619_100_0	4	Preferred Generic	4	11	3	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	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	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	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												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	101	0	1	01	01	H5619_101_0	4	Preferred Generic	4	11	3	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	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	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	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												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	102	0	1	01	01	H5619_102_0	4	Preferred Generic	4	11	3	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	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	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	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	3	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	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	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	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												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_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	109	0	1	01	01	H5619_109_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_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	110	0	1	01	01	H5619_110_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	110	0	1	01	01	H5619_110_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	110	0	1	01	01	H5619_110_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	110	0	1	01	01	H5619_110_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	110	0	1	01	01	H5619_110_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	111	0	1	01	01	H5619_111_0	3	Preferred Generic	4	11	3	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	111	0	1	01	01	H5619_111_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	01	01	H5619_111_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	01	01	H5619_111_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	01	01	H5619_111_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	112	0	1	01	01	H5619_112_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												
H5619	112	0	1	01	01	H5619_112_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_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												
H5619	113	0	1	01	01	H5619_113_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												
H5619	113	0	1	01	01	H5619_113_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_0	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 Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_0	3	Preferred Generic	4	11	3	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	114	0	1	01	01	H5619_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_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	115	0	1	01	01	H5619_115_0	3	Preferred Generic	4	11	3	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	115	0	1	01	01	H5619_115_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	115	0	1	01	01	H5619_115_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	115	0	1	01	01	H5619_115_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	115	0	1	01	01	H5619_115_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	116	0	1	01	01	H5619_116_0	6	Preferred Generic	4	11	3	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	116	0	1	01	01	H5619_116_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_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		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_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		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_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												
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				98.23	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				451.66	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	006	0	1	01	01	H5628_006_0	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				92.13	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	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				449.83	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	6	Preferred Generic	4	11	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, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_0	6	Generic	4	11	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, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_0	6	Preferred Brand	4	11	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, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_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, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_0	6	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				771.83	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_0	6	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	4	Preferred Generic	4	11	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, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	4	Generic	4	11	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, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	4	Preferred Brand	4	11	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, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	4	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, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				836.81	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	4	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	5	Preferred Generic	4	11	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, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	5	Generic	4	11	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, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	5	Preferred Brand	4	11	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, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_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, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	5	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				748.78	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	5	Select Care Drugs	4	11	1	2	6	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, Select Care Drugs												
H5644	002	0	1	01	01	H5644_002_0	6	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		0.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5644	002	0	1	01	01	H5644_002_0	6	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												
H5644	002	0	1	01	01	H5644_002_0	6	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												
H5644	002	0	1	01	01	H5644_002_0	6	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												
H5644	002	0	1	01	01	H5644_002_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 Brand, Specialty Tier												
H5649	001	0	1	01	01	H5649_001_0	5	Preferred Generic	4	11	3	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	5	Preferred Generic	4	11	3	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		3
H5649	001	0	1	01	01	H5649_001_0	5	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	5	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	5	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, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	5	Non-Preferred Drug	4	11	3	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	5	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	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	002	0	1	01	01	H5649_002_0	5	Preferred Generic	4	11	3	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	3	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		3
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	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	002	0	1	01	01	H5649_002_0	5	Non-Preferred Drug	4	11	3	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	5	Preferred Generic	4	11	3	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	5	Preferred Generic	4	11	3	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		3
H5649	004	0	1	01	01	H5649_004_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	004	0	1	01	01	H5649_004_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	004	0	1	01	01	H5649_004_0	5	Preferred Brand	4	11	1	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	5	Non-Preferred Drug	4	11	3	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	5	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	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	006	0	1	01	01	H5649_006_0	6	Preferred Generic	4	11	3	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	3	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		3
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	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, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	6	Non-Preferred Drug	4	11	3	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	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H5649	008	0	1	01	01	H5649_008_0	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	3	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	4	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	4	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	009	0	1	01	01	H5649_009_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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		3
H5649	009	0	1	01	01	H5649_009_0	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	3	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	4	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	4	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	013	0	1	01	01	H5649_013_0	5	Preferred Generic	4	11	3	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	013	0	1	01	01	H5649_013_0	5	Preferred Generic	4	11	3	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		3
H5649	013	0	1	01	01	H5649_013_0	5	Generic	4	11	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												
H5649	013	0	1	01	01	H5649_013_0	5	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	013	0	1	01	01	H5649_013_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												
H5649	013	0	1	01	01	H5649_013_0	5	Non-Preferred Drug	4	11	3	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	013	0	1	01	01	H5649_013_0	5	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	013	0	1	01	01	H5649_013_0	5	Select Care Drugs	4	10	1	2	6	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	014	0	1	01	01	H5649_014_0	5	Preferred Generic	4	11	3	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	014	0	1	01	01	H5649_014_0	5	Preferred Generic	4	11	3	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		3
H5649	014	0	1	01	01	H5649_014_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	014	0	1	01	01	H5649_014_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	014	0	1	01	01	H5649_014_0	5	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	014	0	1	01	01	H5649_014_0	5	Non-Preferred Drug	4	11	3	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	014	0	1	01	01	H5649_014_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	014	0	1	01	01	H5649_014_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	016	0	1	01	01	H5649_016_0	5	Preferred Generic	4	11	3	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	016	0	1	01	01	H5649_016_0	5	Preferred Generic	4	11	3	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		3
H5649	016	0	1	01	01	H5649_016_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	016	0	1	01	01	H5649_016_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	016	0	1	01	01	H5649_016_0	5	Preferred Brand	4	11	1	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	016	0	1	01	01	H5649_016_0	5	Non-Preferred Drug	4	11	3	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	016	0	1	01	01	H5649_016_0	5	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	016	0	1	01	01	H5649_016_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																					30.00																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	2	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1170.00	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	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	2	Generic	4	01	1	2	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				464.00	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	2	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	2	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	2	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	2	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				908.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				1018.00	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	6	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								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	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	6	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		25.00					5.00		12.50											10.00		25.00				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												
H5656	001	0	1	01	01	H5656_001_0	6	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								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	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								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	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_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												
H5746	016	0	1	01	01	H5746_016_0	8	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								12.00	24.00	36.00					12.00	24.00	36.00					12.00		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	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H5746	016	0	1	01	01	H5746_016_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	10	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					3.00		6.00							6.00																10.00				3.00			0.33	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	10	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					3.00		6.00							6.00																10.00				3.00			0.33	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5774	005	0	1	01	01	H5774_005_0	10	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					7.00		14.00							14.00																20.00				7.00			0.67	0.23				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	10	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					7.00		14.00							14.00																20.00				7.00			0.67	0.23				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5774	005	0	1	01	01	H5774_005_0	10	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					30.00		60.00							60.00																45.00				30.00			1.50	1.00				0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	10	Non-Preferred Drug	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 Drug, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	10	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	10	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5774	022	0	1	01	01	H5774_022_0	9	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								6.00		12.00					2.00		4.00							4.00																6.00				2.00			0.20	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	9	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								6.00		12.00					2.00		4.00							4.00																6.00				2.00			0.20	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5774	022	0	1	01	01	H5774_022_0	9	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					5.00		10.00							10.00																15.00				5.00			0.50	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	9	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					5.00		10.00							10.00																15.00				5.00			0.50	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5774	022	0	1	01	01	H5774_022_0	9	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					30.00		60.00							60.00																45.00				30.00			1.50	1.00				0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	9	Non-Preferred Drug	4	11	1	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 Drug, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	9	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 Drug, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	9	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	9	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5774	023	0	1	02	01	H5774_023_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					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	023	0	1	02	01	H5774_023_0	10	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 Drug, Specialty Tier, Select Care Drugs										1		
H5774	023	0	1	02	01	H5774_023_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H5774	023	0	1	02	01	H5774_023_0	10	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 Drug, Specialty Tier, Select Care Drugs										1		
H5774	023	0	1	02	01	H5774_023_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H5774	023	0	1	02	01	H5774_023_0	10	Non-Preferred Drug	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 Drug, Specialty Tier, Select Care Drugs												
H5774	023	0	1	02	01	H5774_023_0	10	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 Drug, Specialty Tier, Select Care Drugs												
H5774	023	0	1	02	01	H5774_023_0	10	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	023	0	1	02	01	H5774_023_0	10	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5774	024	0	1	01	01	H5774_024_0	9	Preferred Generic	2	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 Drug, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	9	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	9	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 Drug, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	9	Non-Preferred Drug	2	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		190.00					60.00		120.00							120.00																95.00				60.00			3.17	2.00				1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	9	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 Drug, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	9	Select Care Drugs	2	01	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	9	Preferred Generic	2	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 Drug, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	9	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	9	Preferred Brand	2	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					30.00		60.00							60.00																45.00				30.00			1.50	1.00				0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	9	Non-Preferred Drug	2	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		190.00					55.00		110.00							110.00																95.00				55.00			3.17	1.83				1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	9	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 Drug, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	9	Select Care Drugs	2	01	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	11	Preferred Generic	2	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 Drug, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	11	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	11	Preferred Brand	2	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					40.00		80.00							80.00																45.00				40.00			1.50	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	11	Non-Preferred Drug	2	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		190.00					70.00		140.00							140.00																95.00				70.00			3.17	2.33				2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	11	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 Drug, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	11	Select Care Drugs	2	01	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	9	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								4.00		8.00					2.00		4.00							4.00																4.00				2.00			0.13	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	9	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								4.00		8.00					2.00		4.00							4.00																4.00				2.00			0.13	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5774	027	0	1	02	01	H5774_027_0	9	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					4.00		8.00							8.00																8.00				4.00			0.27	0.13				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	9	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					4.00		8.00							8.00																8.00				4.00			0.27	0.13				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5774	027	0	1	02	01	H5774_027_0	9	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								30.00		60.00					15.00		30.00							30.00																30.00				15.00			1.00	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	9	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								70.00		140.00					40.00		80.00							80.00																70.00				40.00			2.33	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	9	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 Drug, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	9	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	9	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5774	028	0	1	01	01	H5774_028_0	9	Preferred Generic	2	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 Drug, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	9	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	9	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 Drug, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	9	Non-Preferred Drug	2	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		190.00					60.00		120.00							120.00																95.00				60.00			3.17	2.00				1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	9	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 Drug, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	9	Select Care Drugs	2	01	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5779	002	0	1	01	01	H5779_002_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	002	0	1	01	01	H5779_002_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	002	0	1	01	01	H5779_002_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	002	0	1	01	01	H5779_002_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	002	0	1	01	01	H5779_002_0	4	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	002	0	1	01	01	H5779_002_0	4	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	005	0	1	01	01	H5779_005_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	005	0	1	01	01	H5779_005_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	005	0	1	01	01	H5779_005_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	005	0	1	01	01	H5779_005_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	005	0	1	01	01	H5779_005_0	4	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	005	0	1	01	01	H5779_005_0	4	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	4	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				5.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	006	0	1	01	01	H5779_006_0	4	Generic	4	11	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				10.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	006	0	1	01	01	H5779_006_0	4	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				50.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	006	0	1	01	01	H5779_006_0	4	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	006	0	1	01	01	H5779_006_0	4	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				250.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5779	006	0	1	01	01	H5779_006_0	4	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	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	001	0	1	01	01	H5793_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	001	0	1	01	01	H5793_001_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_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	10.00					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		
H5793	001	0	1	01	01	H5793_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	001	0	1	01	01	H5793_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												
H5793	001	0	1	01	01	H5793_001_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												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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												
H5793	012	0	1	01	01	H5793_012_0	3	Preferred Generic	4	01	1	2	1	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												
H5793	012	0	1	01	01	H5793_012_0	3	Preferred Generic	4	01	1	2	1	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		
H5793	012	0	1	01	01	H5793_012_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H5793	012	0	1	01	01	H5793_012_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H5793	012	0	1	01	01	H5793_012_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	012	0	1	01	01	H5793_012_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	012	0	1	01	01	H5793_012_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	3	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	3	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	3	Preferred Brand	3	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.29			1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	3	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.09	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	3	Specialty Tier	3	11	1	1	5	1	010		01	010		1	31								31						31		31				554.04	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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				98.22	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				522.75	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	1	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												
H5826	008	0	1	01	01	H5826_008_0	8	Generic	4	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					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												
H5826	008	0	1	01	01	H5826_008_0	8	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	140.00					42.00	84.00	125.00					42.00	84.00	125.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											78.87	50	50	50				78.87	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	8	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												
H5826	009	0	1	01	01	H5826_009_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	1	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												
H5826	009	0	1	01	01	H5826_009_0	8	Generic	4	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					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												
H5826	009	0	1	01	01	H5826_009_0	8	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	140.00					42.00	84.00	125.00					42.00	84.00	125.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											83.46	50	50	50				83.46	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	8	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												
H5826	010	0	1	01	01	H5826_010_0	8	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	1	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												
H5826	010	0	1	01	01	H5826_010_0	8	Generic	4	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					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												
H5826	010	0	1	01	01	H5826_010_0	8	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	140.00					42.00	84.00	125.00					42.00	84.00	125.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											84.53	50	50	50				84.53	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	8	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												
H5826	016	0	1	01	01	H5826_016_0	7	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	1	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												
H5826	016	0	1	01	01	H5826_016_0	7	Generic	4	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					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												
H5826	016	0	1	01	01	H5826_016_0	7	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	140.00					42.00	84.00	125.00					42.00	84.00	125.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	016	0	1	01	01	H5826_016_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											83.15	50	50	50				83.15	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	016	0	1	01	01	H5826_016_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 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				13.95	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				89.34	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				66.49	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				597.72	25																																						25		25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5854	007	0	1	01	01	H5854_007_0	5	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	007	0	1	01	01	H5854_007_0	5	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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												
H5854	007	0	1	01	01	H5854_007_0	5	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00		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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H5854	007	0	1	01	01	H5854_007_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	5	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	4	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								3.00	6.00	9.00					3.00	6.00	9.00					3.00		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	4	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								18.00	36.00	54.00					18.00	36.00	54.00					18.00		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												
H5854	008	0	1	01	01	H5854_008_0	4	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H5854	008	0	1	01	01	H5854_008_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	4	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	5	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00		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												
H5854	009	0	1	01	01	H5854_009_0	5	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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												
H5854	009	0	1	01	01	H5854_009_0	5	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H5854	009	0	1	01	01	H5854_009_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	5	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	110		1				30	60	90	1	2	30		90				30		34								5.00	10.00	15.00					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	110		1				30	60	90	1	2	30		90				30		34								19.00	38.00	57.00					14.00	28.00	42.00					14.00		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	110		1				30	60	90	1	2	30		90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00		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	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	110		1				30	60	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	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	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	011	0	1	01	01	H5854_011_0	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00		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												
H5854	011	0	1	01	01	H5854_011_0	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	011	0	1	01	01	H5854_011_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	011	0	1	01	01	H5854_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												
H5854	011	0	1	01	01	H5854_011_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	012	0	1	02	01	H5854_012_0	9	Preferred Generic	3	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		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	012	0	1	02	01	H5854_012_0	9	Generic	3	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	012	0	1	02	01	H5854_012_0	9	Preferred Brand	3	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	012	0	1	02	01	H5854_012_0	9	Non-Preferred Drug	3	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00		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												
H5854	012	0	1	02	01	H5854_012_0	9	Specialty Tier	3	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	012	0	1	02	01	H5854_012_0	9	Select Care Drugs	3	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	1	1	02	01	H5883_002_1	7	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, Select Care Drugs												
H5883	002	1	1	02	01	H5883_002_1	7	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, Select Care Drugs												
H5883	002	1	1	02	01	H5883_002_1	7	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, Select Care Drugs												
H5883	002	1	1	02	01	H5883_002_1	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											50.00	45		45				50.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	1	1	02	01	H5883_002_1	7	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, Select Care Drugs												
H5883	002	1	1	02	01	H5883_002_1	7	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	2	1	02	01	H5883_002_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, Select Care Drugs												
H5883	002	2	1	02	01	H5883_002_2	6	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, Select Care Drugs												
H5883	002	2	1	02	01	H5883_002_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, Select Care Drugs												
H5883	002	2	1	02	01	H5883_002_2	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											50.00	45		45				50.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	2	1	02	01	H5883_002_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, Select Care Drugs												
H5883	002	2	1	02	01	H5883_002_2	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	3	1	02	01	H5883_002_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, Select Care Drugs												
H5883	002	3	1	02	01	H5883_002_3	6	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, Select Care Drugs												
H5883	002	3	1	02	01	H5883_002_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, Select Care Drugs												
H5883	002	3	1	02	01	H5883_002_3	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											50.00	45		45				50.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	3	1	02	01	H5883_002_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, Select Care Drugs												
H5883	002	3	1	02	01	H5883_002_3	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	4	1	02	01	H5883_002_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, Select Care Drugs												
H5883	002	4	1	02	01	H5883_002_4	6	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, Select Care Drugs												
H5883	002	4	1	02	01	H5883_002_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, Select Care Drugs												
H5883	002	4	1	02	01	H5883_002_4	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											50.00	45		45				50.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	4	1	02	01	H5883_002_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, Select Care Drugs												
H5883	002	4	1	02	01	H5883_002_4	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	7	1	02	01	H5883_002_7	7	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, Select Care Drugs												
H5883	002	7	1	02	01	H5883_002_7	7	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, Select Care Drugs												
H5883	002	7	1	02	01	H5883_002_7	7	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, Select Care Drugs												
H5883	002	7	1	02	01	H5883_002_7	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											50.00	45		45				50.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	7	1	02	01	H5883_002_7	7	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, Select Care Drugs												
H5883	002	7	1	02	01	H5883_002_7	7	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	1	1	02	01	H5883_003_1	8	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, Select Care Drugs												
H5883	003	1	1	02	01	H5883_003_1	8	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, Select Care Drugs												
H5883	003	1	1	02	01	H5883_003_1	8	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, Select Care Drugs												
H5883	003	1	1	02	01	H5883_003_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											39.00	45		45				39.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	1	1	02	01	H5883_003_1	8	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, Select Care Drugs												
H5883	003	1	1	02	01	H5883_003_1	8	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	2	1	02	01	H5883_003_2	7	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, Select Care Drugs												
H5883	003	2	1	02	01	H5883_003_2	7	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, Select Care Drugs												
H5883	003	2	1	02	01	H5883_003_2	7	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, Select Care Drugs												
H5883	003	2	1	02	01	H5883_003_2	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											39.00	45		45				39.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	2	1	02	01	H5883_003_2	7	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, Select Care Drugs												
H5883	003	2	1	02	01	H5883_003_2	7	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	3	1	02	01	H5883_003_3	7	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, Select Care Drugs												
H5883	003	3	1	02	01	H5883_003_3	7	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, Select Care Drugs												
H5883	003	3	1	02	01	H5883_003_3	7	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, Select Care Drugs												
H5883	003	3	1	02	01	H5883_003_3	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											39.00	45		45				39.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	3	1	02	01	H5883_003_3	7	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, Select Care Drugs												
H5883	003	3	1	02	01	H5883_003_3	7	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	4	1	02	01	H5883_003_4	7	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, Select Care Drugs												
H5883	003	4	1	02	01	H5883_003_4	7	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, Select Care Drugs												
H5883	003	4	1	02	01	H5883_003_4	7	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, Select Care Drugs												
H5883	003	4	1	02	01	H5883_003_4	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											39.00	45		45				39.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	4	1	02	01	H5883_003_4	7	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, Select Care Drugs												
H5883	003	4	1	02	01	H5883_003_4	7	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	5	1	02	01	H5883_003_5	8	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, Select Care Drugs												
H5883	003	5	1	02	01	H5883_003_5	8	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, Select Care Drugs												
H5883	003	5	1	02	01	H5883_003_5	8	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, Select Care Drugs												
H5883	003	5	1	02	01	H5883_003_5	8	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											39.00	45		45				39.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	5	1	02	01	H5883_003_5	8	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, Select Care Drugs												
H5883	003	5	1	02	01	H5883_003_5	8	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	004	1	1	02	01	H5883_004_1	7	Preferred Generic	4	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, Select Care Drugs												
H5883	004	1	1	02	01	H5883_004_1	7	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, Select Care Drugs												
H5883	004	1	1	02	01	H5883_004_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, Select Care Drugs												
H5883	004	1	1	02	01	H5883_004_1	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											76.00	50		50				76.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	004	1	1	02	01	H5883_004_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, Select Care Drugs												
H5883	004	1	1	02	01	H5883_004_1	7	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	004	2	1	02	01	H5883_004_2	5	Preferred Generic	4	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, Select Care Drugs												
H5883	004	2	1	02	01	H5883_004_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, Select Care Drugs												
H5883	004	2	1	02	01	H5883_004_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, Select Care Drugs												
H5883	004	2	1	02	01	H5883_004_2	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											76.00	50		50				76.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	004	2	1	02	01	H5883_004_2	5	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, Select Care Drugs												
H5883	004	2	1	02	01	H5883_004_2	5	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	004	3	1	02	01	H5883_004_3	6	Preferred Generic	4	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, Select Care Drugs												
H5883	004	3	1	02	01	H5883_004_3	6	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, Select Care Drugs												
H5883	004	3	1	02	01	H5883_004_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, Select Care Drugs												
H5883	004	3	1	02	01	H5883_004_3	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											76.00	50		50				76.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	004	3	1	02	01	H5883_004_3	6	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, Select Care Drugs												
H5883	004	3	1	02	01	H5883_004_3	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	004	4	1	02	01	H5883_004_4	6	Preferred Generic	4	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, Select Care Drugs												
H5883	004	4	1	02	01	H5883_004_4	6	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, Select Care Drugs												
H5883	004	4	1	02	01	H5883_004_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, Select Care Drugs												
H5883	004	4	1	02	01	H5883_004_4	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											76.00	50		50				76.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	004	4	1	02	01	H5883_004_4	6	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, Select Care Drugs												
H5883	004	4	1	02	01	H5883_004_4	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	004	5	1	02	01	H5883_004_5	7	Preferred Generic	4	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, Select Care Drugs												
H5883	004	5	1	02	01	H5883_004_5	7	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, Select Care Drugs												
H5883	004	5	1	02	01	H5883_004_5	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, Select Care Drugs												
H5883	004	5	1	02	01	H5883_004_5	7	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											76.00	50		50				76.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	004	5	1	02	01	H5883_004_5	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, Select Care Drugs												
H5883	004	5	1	02	01	H5883_004_5	7	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	007	0	1	01	01	H5883_007_0	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, Select Care Drugs												
H5883	007	0	1	01	01	H5883_007_0	6	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, Select Care Drugs												
H5883	007	0	1	01	01	H5883_007_0	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, Select Care Drugs												
H5883	007	0	1	01	01	H5883_007_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											50.00	48		48				50.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	007	0	1	01	01	H5883_007_0	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, Select Care Drugs												
H5883	007	0	1	01	01	H5883_007_0	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	008	1	1	01	01	H5883_008_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, Select Care Drugs												
H5883	008	1	1	01	01	H5883_008_1	6	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, Select Care Drugs												
H5883	008	1	1	01	01	H5883_008_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, Select Care Drugs												
H5883	008	1	1	01	01	H5883_008_1	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											44.00	48		48				44.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	008	1	1	01	01	H5883_008_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, Select Care Drugs												
H5883	008	1	1	01	01	H5883_008_1	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	008	2	1	01	01	H5883_008_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, Select Care Drugs												
H5883	008	2	1	01	01	H5883_008_2	6	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, Select Care Drugs												
H5883	008	2	1	01	01	H5883_008_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, Select Care Drugs												
H5883	008	2	1	01	01	H5883_008_2	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											44.00	48		48				44.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	008	2	1	01	01	H5883_008_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, Select Care Drugs												
H5883	008	2	1	01	01	H5883_008_2	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	009	1	1	01	01	H5883_009_1	6	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, Select Care Drugs												
H5883	009	1	1	01	01	H5883_009_1	6	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, Select Care Drugs												
H5883	009	1	1	01	01	H5883_009_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, Select Care Drugs												
H5883	009	1	1	01	01	H5883_009_1	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											58.00	50		50				58.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	009	1	1	01	01	H5883_009_1	6	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, Select Care Drugs												
H5883	009	1	1	01	01	H5883_009_1	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	009	2	1	01	01	H5883_009_2	6	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, Select Care Drugs												
H5883	009	2	1	01	01	H5883_009_2	6	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, Select Care Drugs												
H5883	009	2	1	01	01	H5883_009_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, Select Care Drugs												
H5883	009	2	1	01	01	H5883_009_2	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											58.00	50		50				58.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	009	2	1	01	01	H5883_009_2	6	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, Select Care Drugs												
H5883	009	2	1	01	01	H5883_009_2	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	009	3	1	01	01	H5883_009_3	6	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, Select Care Drugs												
H5883	009	3	1	01	01	H5883_009_3	6	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, Select Care Drugs												
H5883	009	3	1	01	01	H5883_009_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, Select Care Drugs												
H5883	009	3	1	01	01	H5883_009_3	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											58.00	50		50				58.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	009	3	1	01	01	H5883_009_3	6	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, Select Care Drugs												
H5883	009	3	1	01	01	H5883_009_3	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	011	1	1	01	01	H5883_011_1	6	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, Select Care Drugs												
H5883	011	1	1	01	01	H5883_011_1	6	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, Select Care Drugs												
H5883	011	1	1	01	01	H5883_011_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, Select Care Drugs												
H5883	011	1	1	01	01	H5883_011_1	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	50		50				62.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	011	1	1	01	01	H5883_011_1	6	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, Select Care Drugs												
H5883	011	1	1	01	01	H5883_011_1	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	011	2	1	01	01	H5883_011_2	6	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, Select Care Drugs												
H5883	011	2	1	01	01	H5883_011_2	6	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, Select Care Drugs												
H5883	011	2	1	01	01	H5883_011_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, Select Care Drugs												
H5883	011	2	1	01	01	H5883_011_2	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	50		50				62.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	011	2	1	01	01	H5883_011_2	6	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, Select Care Drugs												
H5883	011	2	1	01	01	H5883_011_2	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	011	3	1	01	01	H5883_011_3	6	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, Select Care Drugs												
H5883	011	3	1	01	01	H5883_011_3	6	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, Select Care Drugs												
H5883	011	3	1	01	01	H5883_011_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, Select Care Drugs												
H5883	011	3	1	01	01	H5883_011_3	6	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	50		50				62.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	011	3	1	01	01	H5883_011_3	6	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, Select Care Drugs												
H5883	011	3	1	01	01	H5883_011_3	6	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
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	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.35			1.35			1.35	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				99.24	42	42	42																		42	42	42															42			42								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				496.84	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	004	0	1	01	01	H5928_004_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	004	0	1	01	01	H5928_004_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	3	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1454.34	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	010	0	1	01	01	H5928_010_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	010	0	1	01	01	H5928_010_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	4	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1557.81	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	016	0	1	01	01	H5928_016_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	016	0	1	01	01	H5928_016_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	2	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1139.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	037	0	1	01	01	H5928_037_0	3	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				5.36	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	3	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				106.97	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				156.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	3	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				836.97	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	044	0	1	01	01	H5928_044_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	044	0	1	01	01	H5928_044_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	2	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				2423.60	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_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	0.00	0.00	0.00																			0.00	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	001	0	1	01	01	H5932_001_0	12	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		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_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	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												
H5932	001	0	1	01	01	H5932_001_0	12	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												
H5932	001	0	1	01	01	H5932_001_0	12	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				580.36	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	009	0	1	01	01	H5932_009_0	12	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												
H5932	009	0	1	01	01	H5932_009_0	12	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		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	009	0	1	01	01	H5932_009_0	12	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												
H5932	009	0	1	01	01	H5932_009_0	12	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												
H5932	009	0	1	01	01	H5932_009_0	12	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				609.70	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5938	001	0	1	01	01	H5938_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	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	6	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	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																			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	6	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	6	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	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	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	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	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	5	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	5	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	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 Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_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	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	5	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	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	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 Drug, Specialty Tier												
H5943	001	0	1	02	01	H5943_001_0	4	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	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 Drug, Specialty Tier												
H5943	001	0	1	02	01	H5943_001_0	4	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											91.24	25	25	25				91.24	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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											100.80	25	25	25				100.80	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	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												
H5943	002	0	1	02	01	H5943_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								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	002	0	1	02	01	H5943_002_0	4	Generic	4	11	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											4.76	25	25	25				4.76	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	4	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											93.58	25	25	25				93.58	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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											112.19	25	25	25				112.19	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	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												
H5945	001	0	1	01	01	H5945_001_0	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	6.00	12.00	18.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	9	Generic	4	01	3	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	16.00	32.00	48.00																					32.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	100				1	2			100				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, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				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	9	Specialty Tier	4	10	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, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	9	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	100				1	2			100					29	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	9	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	100				1	2			100					29	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	9	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	6.00	12.00	18.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	9	Generic	4	01	3	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	16.00	32.00	48.00																					32.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	9	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	100				1	2			100				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, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				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	9	Specialty Tier	4	10	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, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	9	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	100				1	2			100					29	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	9	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	100				1	2			100					29	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	009	0	1	04	01	H5959_009_0	8	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 Drug, Specialty Tier, Select Care Drugs												
H5959	009	0	1	04	01	H5959_009_0	8	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 Drug, Specialty Tier, Select Care Drugs												
H5959	009	0	1	04	01	H5959_009_0	8	Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											27.72	25	25	25				20.95	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	009	0	1	04	01	H5959_009_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											47.06	50	50	50				40.46	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	009	0	1	04	01	H5959_009_0	8	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 Drug, Specialty Tier, Select Care Drugs												
H5959	009	0	1	04	01	H5959_009_0	8	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 Drug, Specialty Tier, Select Care Drugs												
H5959	010	1	1	04	01	H5959_010_1	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	010	1	1	04	01	H5959_010_1	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	010	1	1	04	01	H5959_010_1	7	Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											23.51	20	20	20				17.00	15	15	15				15	15	15															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	010	1	1	04	01	H5959_010_1	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											46.67	50	50	50				40.16	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	010	1	1	04	01	H5959_010_1	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	010	1	1	04	01	H5959_010_1	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	010	2	1	04	01	H5959_010_2	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	010	2	1	04	01	H5959_010_2	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	010	2	1	04	01	H5959_010_2	7	Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											23.51	20	20	20				17.00	15	15	15				15	15	15															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	010	2	1	04	01	H5959_010_2	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											46.67	50	50	50				40.16	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	010	2	1	04	01	H5959_010_2	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	010	2	1	04	01	H5959_010_2	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	011	0	1	04	01	H5959_011_0	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	011	0	1	04	01	H5959_011_0	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	011	0	1	04	01	H5959_011_0	7	Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											23.75	20	20	20				17.17	15	15	15				15	15	15															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	011	0	1	04	01	H5959_011_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											48.48	50	50	50				41.47	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	011	0	1	04	01	H5959_011_0	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	011	0	1	04	01	H5959_011_0	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	012	0	1	04	01	H5959_012_0	7	Preferred Generic	2	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	16.00																			8.00	0.00	0.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	012	0	1	04	01	H5959_012_0	7	Generic	2	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	13.00	26.00	26.00																			13.00	26.00	26.00																13.00				13.00		0.42			0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	012	0	1	04	01	H5959_012_0	7	Preferred Brand	2	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				18.04	22	22	22																		22	22	22															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	012	0	1	04	01	H5959_012_0	7	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				29.24	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	012	0	1	04	01	H5959_012_0	7	Specialty Tier	2	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				75.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	012	0	1	04	01	H5959_012_0	7	Select Care Drugs	2	01	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			8.00	0.00	0.00																0.00				0.00		0.00			0.26			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	013	1	1	04	01	H5959_013_1	7	Preferred Generic	2	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	16.00																			8.00	0.00	0.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	013	1	1	04	01	H5959_013_1	7	Generic	2	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	13.00	26.00	26.00																			13.00	26.00	26.00																13.00				13.00		0.42			0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	013	1	1	04	01	H5959_013_1	7	Preferred Brand	2	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				17.84	22	22	22																		22	22	22															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	013	1	1	04	01	H5959_013_1	7	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				27.94	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	013	1	1	04	01	H5959_013_1	7	Specialty Tier	2	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				75.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	013	1	1	04	01	H5959_013_1	7	Select Care Drugs	2	01	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			8.00	0.00	0.00																0.00				0.00		0.00			0.26			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	013	2	1	04	01	H5959_013_2	7	Preferred Generic	2	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	16.00																			8.00	0.00	0.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	013	2	1	04	01	H5959_013_2	7	Generic	2	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	13.00	26.00	26.00																			13.00	26.00	26.00																13.00				13.00		0.42			0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	013	2	1	04	01	H5959_013_2	7	Preferred Brand	2	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				17.84	22	22	22																		22	22	22															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	013	2	1	04	01	H5959_013_2	7	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				27.94	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	013	2	1	04	01	H5959_013_2	7	Specialty Tier	2	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				75.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	013	2	1	04	01	H5959_013_2	7	Select Care Drugs	2	01	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			8.00	0.00	0.00																0.00				0.00		0.00			0.26			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	014	1	1	04	01	H5959_014_1	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	014	1	1	04	01	H5959_014_1	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	014	1	1	04	01	H5959_014_1	7	Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											26.95	25	25	25				20.74	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	014	1	1	04	01	H5959_014_1	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											45.35	50	50	50				38.97	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	014	1	1	04	01	H5959_014_1	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	014	1	1	04	01	H5959_014_1	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	014	2	1	04	01	H5959_014_2	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	014	2	1	04	01	H5959_014_2	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	014	2	1	04	01	H5959_014_2	7	Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											26.95	25	25	25				20.74	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	014	2	1	04	01	H5959_014_2	7	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											45.35	50	50	50				38.97	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5959	014	2	1	04	01	H5959_014_2	7	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 Drug, Specialty Tier, Select Care Drugs												
H5959	014	2	1	04	01	H5959_014_2	7	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 Drug, Specialty Tier, Select Care Drugs												
H5970	001	0	1	04	01	H5970_001_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												
H5970	001	0	1	04	01	H5970_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_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												
H5970	015	0	1	04	01	H5970_015_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												
H5970	015	0	1	04	01	H5970_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_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												
H5970	018	0	1	04	01	H5970_018_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	018	0	1	04	01	H5970_018_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_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	019	0	1	04	01	H5970_019_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												
H5970	019	0	1	04	01	H5970_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_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												
H5970	020	0	1	04	01	H5970_020_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												
H5970	020	0	1	04	01	H5970_020_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	020	0	1	04	01	H5970_020_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	020	0	1	04	01	H5970_020_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	020	0	1	04	01	H5970_020_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												
H5970	021	0	1	04	01	H5970_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												
H5970	021	0	1	04	01	H5970_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	021	0	1	04	01	H5970_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	021	0	1	04	01	H5970_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	021	0	1	04	01	H5970_021_0	5	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												
H5970	022	0	1	04	01	H5970_022_0	5	Preferred Generic	4	11	3	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												
H5970	022	0	1	04	01	H5970_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	022	0	1	04	01	H5970_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	022	0	1	04	01	H5970_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	022	0	1	04	01	H5970_022_0	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 Drug, Specialty Tier												
H5970	023	0	1	04	01	H5970_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					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	023	0	1	04	01	H5970_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	023	0	1	04	01	H5970_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	023	0	1	04	01	H5970_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	023	0	1	04	01	H5970_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												
H5989	002	0	1	01	01	H5989_002_0	4	Generic	3	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	5.75		17.25																					17.25																5.75				5.75		0.19						0.19	Generic, Brand												
H5989	002	0	1	01	01	H5989_002_0	4	Brand	3	10	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				63.94	25		25																				25															25			25								Generic, Brand												
H5991	001	0	1	01	01	H5991_001_0	9	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	9	Generic	3	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	6.00	12.00	15.00																					15.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	9	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	9	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	9	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	7	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	7	Generic	3	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	7.00	14.00	17.50																					17.50																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	7	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	7	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	7	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	6	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	1.00	2.00	2.50																					2.50																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	6	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	6	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	30.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_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	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				585.00	27																																					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	6	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	1.00	2.00	2.50																					2.50																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	6	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	6	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	30.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_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	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	6	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	6	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				652.50	27																																					27			27								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	0.00	3.40	0.00	3.40			0.00	3.40			
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	0.00	8.50	0.00	8.50			0.00	8.50			
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	9	Preferred Generic	3	11	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												
H6154	001	0	1	02	01	H6154_001_0	9	Generic	3	11	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												
H6154	001	0	1	02	01	H6154_001_0	9	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	41.00		123.00																					82.00																41.00				41.00		1.37						1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	001	0	1	02	01	H6154_001_0	9	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				83.16	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	001	0	1	02	01	H6154_001_0	9	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												
H6154	002	0	1	02	01	H6154_002_0	9	Preferred Generic	3	11	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												
H6154	002	0	1	02	01	H6154_002_0	9	Generic	3	11	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												
H6154	002	0	1	02	01	H6154_002_0	9	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	44.00		132.00																					88.00																44.00				44.00		1.47						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	002	0	1	02	01	H6154_002_0	9	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				84.68	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	002	0	1	02	01	H6154_002_0	9	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												
H6229	005	0	1	48	05	H6229_005_0	2	Generic Drugs	4	11			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	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	2	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	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	2	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	2	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	2	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	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	2	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	0.00	8.50			0.00	8.50	0.00	8.50			
H6229	006	0	1	48	05	H6229_006_0	2	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	2	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								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												
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												
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												
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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											1400.70	29						1400.70	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	005	0	1	01	01	H6237_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								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												
H6237	005	0	1	01	01	H6237_005_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												
H6237	005	0	1	01	01	H6237_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	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												
H6237	005	0	1	01	01	H6237_005_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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	005	0	1	01	01	H6237_005_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1593.90	33						1593.90	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	002	0	1	01	01	H6306_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	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	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	002	0	1	01	01	H6306_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																			18.00	36.00	45.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6306	002	0	1	01	01	H6306_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												
H6306	002	0	1	01	01	H6306_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												
H6306	002	0	1	01	01	H6306_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												
H6306	002	0	1	01	01	H6306_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	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	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	003	0	1	01	01	H6306_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	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	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																			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	3	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	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	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	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	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	3	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	3	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	3	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	01	01	H6306_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	0.00	0.00	0.00																			0.00	0.00	0.00																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	01	01	H6306_005_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 Drug, Specialty Tier, Select Care Drugs										1		
H6306	005	0	1	01	01	H6306_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	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	01	01	H6306_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																			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	01	01	H6306_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	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	01	01	H6306_005_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				750.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6306	005	0	1	01	01	H6306_005_0	3	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	005	0	1	01	01	H6306_005_0	3	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	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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6306	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	0.00	0.00	0.00																			0.00	0.00	0.00																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	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	9.00	18.00	27.00																			9.00	18.00	22.50																9.00				9.00		0.30			0.30			0.29	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	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 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	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	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	31																				31																	31			31								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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6306	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	0.00	0.00	0.00																			0.00	0.00	0.00																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	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	4.00	8.00	12.00																			4.00	0.00	0.00																4.00				4.00		0.13			0.13			0.13	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	4.00	8.00	12.00																			4.00	0.00	0.00																4.00				4.00		0.13			0.13			0.13	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	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 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	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 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	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	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	4.00	4.00	0.00																			4.00	4.00	0.00																4.00				4.00		0.13			0.13			0.13	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	4.00	4.00	0.00																			4.00	4.00	0.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
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	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		
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	Preferred Brand	4	11	1	2	3	3	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										2	3	
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	5	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	5	Preferred Generic	4	01	1	2	1	3	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										1		
H6328	002	0	1	04	01	H6328_002_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												
H6328	002	0	1	04	01	H6328_002_0	5	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	5	Preferred Brand	4	11	1	2	3	3	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										2	3	
H6328	002	0	1	04	01	H6328_002_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	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	5	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	5	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	5	Preferred Generic	4	01	1	2	1	3	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										1		
H6328	003	0	1	04	01	H6328_003_0	5	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	5	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	5	Preferred Brand	4	11	1	2	3	3	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										2	3	
H6328	003	0	1	04	01	H6328_003_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	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	5	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	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 Drug, Specialty Tier, Select Care Drugs												
H6348	001	0	1	04	01	H6348_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					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, Select Care Drugs												
H6348	001	0	1	04	01	H6348_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					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 Drug, Specialty Tier, Select Care Drugs												
H6348	001	0	1	04	01	H6348_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					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 Drug, Specialty Tier, Select Care Drugs												
H6348	001	0	1	04	01	H6348_001_0	5	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, Select Care Drugs												
H6348	001	0	1	04	01	H6348_001_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 Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_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								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 Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_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	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, Select Care Drugs												
H6348	002	0	1	04	01	H6348_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					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 Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_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					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 Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_002_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, Select Care Drugs												
H6348	002	0	1	04	01	H6348_002_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 Drug, Specialty Tier, Select Care Drugs												
H6348	003	0	1	04	01	H6348_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								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 Drug, Specialty Tier, Select Care Drugs												
H6348	003	0	1	04	01	H6348_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	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, Select Care Drugs												
H6348	003	0	1	04	01	H6348_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					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 Drug, Specialty Tier, Select Care Drugs												
H6348	003	0	1	04	01	H6348_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					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 Drug, Specialty Tier, Select Care Drugs												
H6348	003	0	1	04	01	H6348_003_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, Select Care Drugs												
H6348	003	0	1	04	01	H6348_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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	004	0	1	04	01	H6348_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								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 Drug, Specialty Tier, Select Care Drugs												
H6348	004	0	1	04	01	H6348_004_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					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, Select Care Drugs												
H6348	004	0	1	04	01	H6348_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 Drug, Specialty Tier, Select Care Drugs												
H6348	004	0	1	04	01	H6348_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					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 Drug, Specialty Tier, Select Care Drugs												
H6348	004	0	1	04	01	H6348_004_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, Select Care Drugs												
H6348	004	0	1	04	01	H6348_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 Drug, Specialty Tier, Select Care Drugs												
H6351	002	0	1	01	01	H6351_002_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6351	002	0	1	01	01	H6351_002_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6351	002	0	1	01	01	H6351_002_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6351	002	0	1	01	01	H6351_002_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6351	002	0	1	01	01	H6351_002_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6396	001	0	1	01	01	H6396_001_0	9	Preferred Generic	4	11	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	9	Generic	4	11	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	9	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	9	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	9	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	9	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												
H6396	002	0	1	01	01	H6396_002_0	9	Generic	4	11	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	9	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	9	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	9	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	9	Preferred Generic	4	11	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	9	Generic	4	11	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	9	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	9	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	9	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	4	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	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	4	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	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	4	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	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6439	002	0	1	01	01	H6439_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	002	0	1	01	01	H6439_002_0	4	Generic	4	11	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		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	002	0	1	01	01	H6439_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		90.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	002	0	1	01	01	H6439_002_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.06	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	002	0	1	01	01	H6439_002_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												
H6453	001	0	1	01	01	H6453_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								10.00	20.00	30.00					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	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	8	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	0.00					3.00	6.00	0.00																10.00				3.00			0.33	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	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					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	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	8	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	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	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					45.00	90.00	135.00					45.00	90.00	135.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	001	0	1	01	01	H6453_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					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 Drug, Specialty Tier												
H6453	001	0	1	01	01	H6453_001_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1083.03	33						628.75	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	002	0	1	01	01	H6453_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								10.00	20.00	30.00					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	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	8	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	0.00					3.00	6.00	0.00																10.00				3.00			0.33	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	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					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	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	8	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	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	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					45.00	90.00	135.00					45.00	90.00	135.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	002	0	1	01	01	H6453_002_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					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 Drug, Specialty Tier												
H6453	002	0	1	01	01	H6453_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1083.56	33						617.34	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	003	0	1	01	01	H6453_003_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	30.00					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	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	8	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	0.00					3.00	6.00	0.00																10.00				3.00			0.33	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	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					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	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	8	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	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	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					45.00	90.00	135.00					45.00	90.00	135.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	003	0	1	01	01	H6453_003_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					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 Drug, Specialty Tier												
H6453	003	0	1	01	01	H6453_003_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1080.13	33						509.31	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	004	0	1	01	01	H6453_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	30.00					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	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	8	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	0.00					3.00	6.00	0.00																10.00				3.00			0.33	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	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					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	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	8	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	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	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					45.00	90.00	135.00					45.00	90.00	135.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	004	0	1	01	01	H6453_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		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 Drug, Specialty Tier												
H6453	004	0	1	01	01	H6453_004_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											978.44	33						591.72	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	005	0	1	01	01	H6453_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								10.00	20.00	30.00					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	005	0	1	01	01	H6453_005_0	8	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	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	005	0	1	01	01	H6453_005_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					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	005	0	1	01	01	H6453_005_0	8	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	005	0	1	01	01	H6453_005_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					45.00	90.00	135.00					45.00	90.00	135.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	005	0	1	01	01	H6453_005_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					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 Drug, Specialty Tier												
H6453	005	0	1	01	01	H6453_005_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1058.57	25						752.35	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	006	0	1	01	01	H6453_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								10.00	20.00	30.00					3.00	6.00	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	006	0	1	01	01	H6453_006_0	8	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	0.00					3.00	6.00	0.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	006	0	1	01	01	H6453_006_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					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	006	0	1	01	01	H6453_006_0	8	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	0.00					12.00	24.00	0.00																18.00				12.00			0.60	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	006	0	1	01	01	H6453_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					45.00	90.00	135.00					45.00	90.00	135.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	006	0	1	01	01	H6453_006_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					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 Drug, Specialty Tier												
H6453	006	0	1	01	01	H6453_006_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1062.44	25						757.93	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	001	0	1	04	01	H6502_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	0.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6502	001	0	1	04	01	H6502_001_0	3	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	0.00																					0.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6502	001	0	1	04	01	H6502_001_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	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6502	001	0	1	04	01	H6502_001_0	3	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																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6502	001	0	1	04	01	H6502_001_0	3	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 Brand, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_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	0.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_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	0.00																					0.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_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	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_0	3	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																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_0	3	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 Brand, Specialty Tier												
H6526	001	0	1	01	01	H6526_001_0	6	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	6	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	6	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						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	6	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	6	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1081.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	01	01	H6526_002_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	5	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	5	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						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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1081.00	30		30																										30						30			30			30								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				2	2						90	30		31	3.00		6.00																											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				2	2						90	30		31	10.00		20.00																											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				2	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				2	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				2	2						90	30		31				834.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	001	0	1	01	01	H6550_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								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 Drug, Specialty Tier, Select Care Drugs												
H6550	001	0	1	01	01	H6550_001_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					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 Drug, Specialty Tier, Select Care Drugs												
H6550	001	0	1	01	01	H6550_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					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 Drug, Specialty Tier, Select Care Drugs												
H6550	001	0	1	01	01	H6550_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					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 Drug, Specialty Tier, Select Care Drugs												
H6550	001	0	1	01	01	H6550_001_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, Select Care Drugs												
H6550	001	0	1	01	01	H6550_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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_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								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 Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_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					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 Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_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					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 Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_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					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 Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_003_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, Select Care Drugs												
H6550	003	0	1	01	01	H6550_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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	004	0	1	01	01	H6550_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 Drug, Specialty Tier, Select Care Drugs												
H6550	004	0	1	01	01	H6550_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 Drug, Specialty Tier, Select Care Drugs												
H6550	004	0	1	01	01	H6550_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 Drug, Specialty Tier, Select Care Drugs												
H6550	004	0	1	01	01	H6550_004_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												
H6550	004	0	1	01	01	H6550_004_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												
H6550	004	0	1	01	01	H6550_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 Drug, Specialty Tier, Select Care Drugs												
H6622	001	0	1	01	01	H6622_001_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												
H6622	001	0	1	01	01	H6622_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_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												
H6622	002	0	1	01	01	H6622_002_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												
H6622	002	0	1	01	01	H6622_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_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												
H6622	004	0	1	01	01	H6622_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	5	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	005	0	1	01	01	H6622_005_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												
H6622	005	0	1	01	01	H6622_005_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	5	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	007	0	1	01	01	H6622_007_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	5	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				82.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	5	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	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												
H6622	008	0	1	01	01	H6622_008_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_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												
H6622	010	0	1	01	01	H6622_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												
H6622	010	0	1	01	01	H6622_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_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												
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	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	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	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					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	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					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	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	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					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	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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_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												
H6622	013	0	1	01	01	H6622_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_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	014	0	1	01	01	H6622_014_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												
H6622	014	0	1	01	01	H6622_014_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_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	015	0	1	01	01	H6622_015_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	015	0	1	01	01	H6622_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_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	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	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	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	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	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, Select Care Drugs												
H6622	017	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_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												
H6622	017	0	1	01	01	H6622_017_0	3	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	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	018	0	1	01	01	H6622_018_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_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												
H6622	019	0	1	01	01	H6622_019_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												
H6622	019	0	1	01	01	H6622_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	6	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					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	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	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	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												33							33												33						33					33			33								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					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	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	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	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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_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												
H6622	022	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_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	023	0	1	01	01	H6622_023_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												
H6622	023	0	1	01	01	H6622_023_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	01	01	H6622_023_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	01	01	H6622_023_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	01	01	H6622_023_0	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 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	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	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	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												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	01	01	H6622_025_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												
H6622	025	0	1	01	01	H6622_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	01	01	H6622_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	01	01	H6622_025_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	01	01	H6622_025_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												
H6622	026	0	1	01	01	H6622_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	01	01	H6622_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	01	01	H6622_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	01	01	H6622_026_0	5	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	027	0	1	01	01	H6622_027_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	027	0	1	01	01	H6622_027_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	027	0	1	01	01	H6622_027_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	027	0	1	01	01	H6622_027_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	027	0	1	01	01	H6622_027_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												
H6622	028	0	1	01	01	H6622_028_0	4	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_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	029	0	1	01	01	H6622_029_0	6	Preferred Generic	4	11	3	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	6	Preferred Generic	4	11	3	2	1	3		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										2	2	3
H6622	029	0	1	01	01	H6622_029_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	029	0	1	01	01	H6622_029_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	029	0	1	01	01	H6622_029_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	029	0	1	01	01	H6622_029_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												
H6622	029	0	1	01	01	H6622_029_0	6	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												17							17												17						17					17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_0	4	Preferred Generic	4	11	3	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	4	Preferred Generic	4	11	3	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	2	3
H6622	030	0	1	01	01	H6622_030_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H6622	030	0	1	01	01	H6622_030_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_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	030	0	1	01	01	H6622_030_0	4	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												17							17												17						17					17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	031	0	1	01	01	H6622_031_0	6	Preferred Generic	4	11	3	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	6	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	031	0	1	01	01	H6622_031_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	031	0	1	01	01	H6622_031_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	031	0	1	01	01	H6622_031_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												
H6622	032	0	1	01	01	H6622_032_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	032	0	1	01	01	H6622_032_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	032	0	1	01	01	H6622_032_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	032	0	1	01	01	H6622_032_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	033	0	1	01	01	H6622_033_0	3	Preferred Generic	4	11	3	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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_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	034	0	1	01	01	H6622_034_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												
H6622	034	0	1	01	01	H6622_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_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												
H6622	035	0	1	01	01	H6622_035_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												
H6622	035	0	1	01	01	H6622_035_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_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	036	0	1	01	01	H6622_036_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												
H6622	036	0	1	01	01	H6622_036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_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	037	0	1	01	01	H6622_037_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												
H6622	037	0	1	01	01	H6622_037_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_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	038	0	1	01	01	H6622_038_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	038	0	1	01	01	H6622_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	038	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	038	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	038	0	1	01	01	H6622_038_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	039	0	1	01	01	H6622_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					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	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	039	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	039	0	1	01	01	H6622_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	039	0	1	01	01	H6622_039_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												
H6622	040	0	1	01	01	H6622_040_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												
H6622	040	0	1	01	01	H6622_040_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	040	0	1	01	01	H6622_040_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	040	0	1	01	01	H6622_040_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	040	0	1	01	01	H6622_040_0	5	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	041	0	1	01	01	H6622_041_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												
H6622	041	0	1	01	01	H6622_041_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	041	0	1	01	01	H6622_041_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	041	0	1	01	01	H6622_041_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	041	0	1	01	01	H6622_041_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												
H6622	043	0	1	01	01	H6622_043_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												
H6622	043	0	1	01	01	H6622_043_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	043	0	1	01	01	H6622_043_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	043	0	1	01	01	H6622_043_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	043	0	1	01	01	H6622_043_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	047	0	1	01	01	H6622_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_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					90.00		270.00											100.00		300.00				90.00		260.00				100.00				100.00			3.33	3		3.33	3	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_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												
H6622	048	0	1	01	01	H6622_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												
H6622	048	0	1	01	01	H6622_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	048	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	048	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	048	0	1	01	01	H6622_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												
H6622	049	0	1	01	01	H6622_049_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	049	0	1	01	01	H6622_049_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_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												
H6622	050	1	1	01	01	H6622_050_1	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												
H6622	050	1	1	01	01	H6622_050_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	050	1	1	01	01	H6622_050_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	050	1	1	01	01	H6622_050_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	050	1	1	01	01	H6622_050_1	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												
H6622	050	2	1	01	01	H6622_050_2	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												
H6622	050	2	1	01	01	H6622_050_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	050	2	1	01	01	H6622_050_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	050	2	1	01	01	H6622_050_2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	050	2	1	01	01	H6622_050_2	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												
H6622	051	0	1	01	01	H6622_051_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												
H6622	051	0	1	01	01	H6622_051_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	051	0	1	01	01	H6622_051_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	051	0	1	01	01	H6622_051_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	051	0	1	01	01	H6622_051_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												
H6622	052	0	1	01	01	H6622_052_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												
H6622	052	0	1	01	01	H6622_052_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_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	053	0	1	01	01	H6622_053_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												
H6622	053	0	1	01	01	H6622_053_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	053	0	1	01	01	H6622_053_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	053	0	1	01	01	H6622_053_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	053	0	1	01	01	H6622_053_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	054	0	1	01	01	H6622_054_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												
H6622	054	0	1	01	01	H6622_054_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_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												
H6622	055	0	1	01	01	H6622_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					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	055	0	1	01	01	H6622_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_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	056	0	1	01	01	H6622_056_0	5	Preferred Generic	4	11	3	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	056	0	1	01	01	H6622_056_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					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	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 Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_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												
H6622	057	0	1	01	01	H6622_057_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_0	5	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	058	0	1	01	01	H6622_058_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												
H6622	058	0	1	01	01	H6622_058_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	058	0	1	01	01	H6622_058_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	058	0	1	01	01	H6622_058_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	058	0	1	01	01	H6622_058_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												
H6672	001	0	1	01	01	H6672_001_0	8	Preferred Generic	4	01	1	1	1	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												
H6672	001	0	1	01	01	H6672_001_0	8	Generic	4	01	3	1	2	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												
H6672	001	0	1	01	01	H6672_001_0	8	Preferred Brand	4	10	1	1	3	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												
H6672	001	0	1	01	01	H6672_001_0	8	Non-Preferred Drug	4	11	1	1	4	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												
H6672	001	0	1	01	01	H6672_001_0	8	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												
H6672	003	0	1	01	01	H6672_003_0	7	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	7	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	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																					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	7	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	7	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				607.31	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	7	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	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	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	004	0	1	01	01	H6672_004_0	8	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	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 Drug, Specialty Tier												
H6672	004	0	1	01	01	H6672_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	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	004	0	1	01	01	H6672_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		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												
H6672	004	0	1	01	01	H6672_004_0	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				653.01	28	28	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	12	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	12	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	1	1	01	01	H6723_001_1	12	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	12	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	1	1	01	01	H6723_001_1	12	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	12	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											47.26	50		50				47.26	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	12	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 Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	9	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	9	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	2	1	01	01	H6723_001_2	9	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	9	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	2	1	01	01	H6723_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		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	9	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											47.26	50		50				47.26	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	9	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 Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	8	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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												
H6723	002	1	1	01	01	H6723_002_1	8	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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										1		
H6723	002	1	1	01	01	H6723_002_1	8	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	8	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	1	1	01	01	H6723_002_1	8	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											45.78	50		50				45.78	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	8	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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												
H6723	002	2	1	01	01	H6723_002_2	8	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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										1		
H6723	002	2	1	01	01	H6723_002_2	8	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	8	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	2	1	01	01	H6723_002_2	8	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											45.78	50		50				45.78	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	1	1	01	01	H6723_003_1	8	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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												
H6723	003	1	1	01	01	H6723_003_1	8	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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										1		
H6723	003	1	1	01	01	H6723_003_1	8	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	1	1	01	01	H6723_003_1	8	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	1	1	01	01	H6723_003_1	8	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	1	1	01	01	H6723_003_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											29.06	50		50				29.06	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	2	1	01	01	H6723_003_2	8	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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												
H6723	003	2	1	01	01	H6723_003_2	8	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					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										1		
H6723	003	2	1	01	01	H6723_003_2	8	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	2	1	01	01	H6723_003_2	8	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	2	1	01	01	H6723_003_2	8	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	2	1	01	01	H6723_003_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											29.06	50		50				29.06	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	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6743	001	0	1	04	01	H6743_001_0	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	11	Non-Preferred Drug	4	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	11	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1054.19	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	11	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												
H6743	003	0	1	04	01	H6743_003_0	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	003	0	1	04	01	H6743_003_0	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	003	0	1	04	01	H6743_003_0	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	003	0	1	04	01	H6743_003_0	11	Non-Preferred Drug	4	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	003	0	1	04	01	H6743_003_0	11	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				795.61	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	003	0	1	04	01	H6743_003_0	11	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												
H6743	004	0	1	04	01	H6743_004_0	12	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 Drug, Specialty Tier, Select Care Drugs												
H6743	004	0	1	04	01	H6743_004_0	12	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 Drug, Specialty Tier, Select Care Drugs												
H6743	004	0	1	04	01	H6743_004_0	12	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 Drug, Specialty Tier, Select Care Drugs												
H6743	004	0	1	04	01	H6743_004_0	12	Non-Preferred Drug	4	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	004	0	1	04	01	H6743_004_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				798.23	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	004	0	1	04	01	H6743_004_0	12	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												
H6743	007	0	1	04	01	H6743_007_0	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	11	Preferred Brand	4	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	11	Non-Preferred Drug	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 Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	11	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1139.48	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	11	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												
H6743	016	0	1	04	01	H6743_016_0	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	016	0	1	04	01	H6743_016_0	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	016	0	1	04	01	H6743_016_0	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	016	0	1	04	01	H6743_016_0	11	Non-Preferred Drug	4	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	016	0	1	04	01	H6743_016_0	11	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				810.48	32																																					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	016	0	1	04	01	H6743_016_0	11	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												
H6743	018	1	1	04	01	H6743_018_1	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	018	1	1	04	01	H6743_018_1	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	018	1	1	04	01	H6743_018_1	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	018	1	1	04	01	H6743_018_1	11	Non-Preferred Drug	4	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	018	1	1	04	01	H6743_018_1	11	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1270.96	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	1	1	04	01	H6743_018_1	11	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												
H6743	018	3	1	04	01	H6743_018_3	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	11	Non-Preferred Drug	4	11	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 Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	11	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1270.96	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	11	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												
H6750	001	0	1	01	01	H6750_001_0	5	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1684.32	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1568.16	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	5	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	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1452.00	25	25	25																		25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	006	0	1	01	01	H6750_006_0	5	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	006	0	1	01	01	H6750_006_0	5	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	006	0	1	01	01	H6750_006_0	5	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	006	0	1	01	01	H6750_006_0	5	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	006	0	1	01	01	H6750_006_0	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1452.00	25	25	25																		25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	007	0	1	01	01	H6750_007_0	5	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	007	0	1	01	01	H6750_007_0	5	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	007	0	1	01	01	H6750_007_0	5	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	007	0	1	01	01	H6750_007_0	5	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	007	0	1	01	01	H6750_007_0	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1510.08	26	26	26																		26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	008	0	1	01	01	H6750_008_0	5	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	008	0	1	01	01	H6750_008_0	5	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	008	0	1	01	01	H6750_008_0	5	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	008	0	1	01	01	H6750_008_0	5	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	008	0	1	01	01	H6750_008_0	5	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	008	0	1	01	01	H6750_008_0	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1916.64	33	33	33																		33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	009	0	1	01	01	H6750_009_0	5	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	009	0	1	01	01	H6750_009_0	5	Generic	4	01	3	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				7.00	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	009	0	1	01	01	H6750_009_0	5	Preferred Brand	4	11	3	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				89.00	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	009	0	1	01	01	H6750_009_0	5	Non-Preferred Brand	4	11	3	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				99.00	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	009	0	1	01	01	H6750_009_0	5	Specialty Tier	4	11	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				1452.00	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	6	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		6.00																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	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		20.00																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	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	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												
H6786	002	0	1	04	01	H6786_002_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6786	002	0	1	04	01	H6786_002_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6815	003	1	1	01	01	H6815_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								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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_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					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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	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					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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_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								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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_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					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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	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					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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	3	1	01	01	H6815_003_3	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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	3	1	01	01	H6815_003_3	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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	3	1	01	01	H6815_003_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	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	003	3	1	01	01	H6815_003_3	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					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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	3	1	01	01	H6815_003_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 Drug, Specialty Tier, Select Care Drugs												
H6815	003	3	1	01	01	H6815_003_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 Drug, Specialty Tier, Select Care Drugs												
H6815	005	0	1	01	01	H6815_005_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					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 Drug, Specialty Tier, Select Care Drugs												
H6815	005	0	1	01	01	H6815_005_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					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 Drug, Specialty Tier, Select Care Drugs												
H6815	005	0	1	01	01	H6815_005_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					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 Drug, Specialty Tier, Select Care Drugs												
H6815	005	0	1	01	01	H6815_005_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					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 Drug, Specialty Tier, Select Care Drugs												
H6815	005	0	1	01	01	H6815_005_0	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 Drug, Specialty Tier, Select Care Drugs												
H6815	005	0	1	01	01	H6815_005_0	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 Drug, Specialty Tier, Select Care Drugs												
H6815	006	0	1	01	01	H6815_006_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 Drug, Specialty Tier, Select Care Drugs												
H6815	006	0	1	01	01	H6815_006_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 Drug, Specialty Tier, Select Care Drugs												
H6815	006	0	1	01	01	H6815_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	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 Drug, Specialty Tier, Select Care Drugs												
H6815	006	0	1	01	01	H6815_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	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 Drug, Specialty Tier, Select Care Drugs												
H6815	006	0	1	01	01	H6815_006_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 Drug, Specialty Tier, Select Care Drugs												
H6815	006	0	1	01	01	H6815_006_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 Drug, Specialty Tier, Select Care Drugs												
H6821	001	0	1	01	01	H6821_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								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	0.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	001	0	1	01	01	H6821_001_0	7	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					7.00	14.00	21.00					14.00	28.00	0.00																14.00				14.00			0.47	0.23	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	001	0	1	01	01	H6821_001_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					42.00	84.00	126.00					47.00	94.00	115.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	001	0	1	01	01	H6821_001_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								97.00	194.00	291.00					87.00	174.00	261.00					97.00	194.00	275.00																97.00				97.00			3.23	2.90	3.23			3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	001	0	1	01	01	H6821_001_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1804.67	33						1804.67	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	002	0	1	01	01	H6821_002_0	8	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					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												
H6821	002	0	1	01	01	H6821_002_0	8	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	0.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	002	0	1	01	01	H6821_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					42.00	84.00	126.00					42.00	84.00	115.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	002	0	1	01	01	H6821_002_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								97.00	194.00	291.00					85.00	170.00	255.00					85.00	170.00	240.00																97.00				97.00			3.23	2.83	2.83			3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	002	0	1	01	01	H6821_002_0	8	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1884.07	33						1884.07	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	003	0	1	01	01	H6821_003_0	7	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	24.00					2.00	4.00	6.00					8.00	16.00	0.00																8.00				8.00			0.27	0.07	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	003	0	1	01	01	H6821_003_0	7	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					7.00	14.00	21.00					15.00	30.00	0.00																15.00				15.00			0.50	0.23	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	003	0	1	01	01	H6821_003_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					42.00	84.00	126.00					47.00	94.00	115.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	003	0	1	01	01	H6821_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		31								97.00	194.00	291.00					85.00	170.00	255.00					97.00	194.00	240.00																97.00				97.00			3.23	2.83	3.23			3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	003	0	1	01	01	H6821_003_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1818.40	33						1818.40	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	004	0	1	01	01	H6821_004_0	7	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	24.00					2.00	4.00	6.00					8.00	16.00	0.00																8.00				8.00			0.27	0.07	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	004	0	1	01	01	H6821_004_0	7	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					7.00	14.00	21.00					15.00	30.00	0.00																15.00				15.00			0.50	0.23	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	004	0	1	01	01	H6821_004_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					42.00	84.00	126.00					47.00	94.00	115.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	004	0	1	01	01	H6821_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		31								97.00	194.00	291.00					85.00	170.00	255.00					97.00	194.00	240.00																97.00				97.00			3.23	2.83	3.23			3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6821	004	0	1	01	01	H6821_004_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1858.38	33						1858.38	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6870	001	0	1	48	05	H6870_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	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	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	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	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			
H6975	001	0	1	01	01	H6975_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	001	0	1	01	01	H6975_001_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	001	0	1	01	01	H6975_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	001	0	1	01	01	H6975_001_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		198.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	001	0	1	01	01	H6975_001_0	4	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												
H6988	001	0	1	01	01	H6988_001_0	7	Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	1			90				30		31	5.00		15.00																					8.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	7	Preferred Brand	4	10	1	2	2	1	110		01	100		1	30		90				1	1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	7	Non-Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	1			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	7	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31					25																																					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	001	0	1	04	01	H7006_001_0	12	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 Drug, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	12	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 Drug, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	12	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 Drug, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	12	Non-Preferred Drug	4	11	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 Drug, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				672.96	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	12	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												
H7006	003	0	1	04	01	H7006_003_0	12	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 Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	12	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 Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	12	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 Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	12	Non-Preferred Drug	4	11	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 Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	12	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				757.65	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	12	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												
H7020	004	0	1	01	01	H7020_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								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	004	0	1	01	01	H7020_004_0	4	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	20.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	004	0	1	01	01	H7020_004_0	4	Preferred Brand	4	11	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											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												
H7020	004	0	1	01	01	H7020_004_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											72.40	50	50	50				68.48	50	50	50										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	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											623.43	27						581.81	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	006	0	1	01	01	H7020_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								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												
H7020	006	0	1	01	01	H7020_006_0	4	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	20.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	006	0	1	01	01	H7020_006_0	4	Preferred Brand	4	11	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											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												
H7020	006	0	1	01	01	H7020_006_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.57	49	49	49				94.38	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	006	0	1	01	01	H7020_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											828.14	33						783.81	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7115	001	0	1	01	01	H7115_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	2.00	4.00	4.00																			2.00	0.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	7	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																			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												
H7115	001	0	1	01	01	H7115_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	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												
H7115	001	0	1	01	01	H7115_001_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	99.00	198.00	198.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7115	001	0	1	01	01	H7115_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												
H7149	001	0	1	01	01	H7149_001_0	3	Preferred Generic	4	01	1	2	1	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												
H7149	001	0	1	01	01	H7149_001_0	3	Preferred Generic	4	01	1	2	1	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		
H7149	001	0	1	01	01	H7149_001_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					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		
H7149	001	0	1	01	01	H7149_001_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_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												
H7149	001	0	1	01	01	H7149_001_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												
H7149	004	0	1	01	01	H7149_004_0	2	Preferred Generic	4	01	1	2	1	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												
H7149	004	0	1	01	01	H7149_004_0	2	Preferred Generic	4	01	1	2	1	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		
H7149	004	0	1	01	01	H7149_004_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					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		
H7149	004	0	1	01	01	H7149_004_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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												
H7165	001	0	1	01	01	H7165_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								8.00	16.00	24.00					3.00	6.00	0.00											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	7	Preferred Generic	4	11	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	0.00											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	7	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					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	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	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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.60	50	50	50				87.84	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	7	Specialty Tier	4	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												
H7165	002	0	1	01	01	H7165_002_0	7	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	24.00					3.00	6.00	0.00											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	7	Preferred Generic	4	11	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	0.00											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	7	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					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	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	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	7	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.66	50	50	50				87.89	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	7	Specialty Tier	4	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												
H7172	001	0	1	48	05	H7172_001_0	7	Generic Drugs	4	11			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	7	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	7	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	7	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	7	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	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	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	7	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	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, Select Care Drugs												
H7173	001	0	1	01	01	H7173_001_0	7	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	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, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	7	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 Drug, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_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	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	002	0	1	01	01	H7173_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		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	002	0	1	01	01	H7173_002_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, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	7	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												
H7173	003	0	1	01	01	H7173_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 Drug, Specialty Tier, Select Care Drugs												
H7173	003	0	1	01	01	H7173_003_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																			16.00	32.00	48.00																16.00				16.00		0.53			0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	003	0	1	01	01	H7173_003_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	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 Drug, Specialty Tier, Select Care Drugs												
H7173	003	0	1	01	01	H7173_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		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 Drug, Specialty Tier, Select Care Drugs												
H7173	003	0	1	01	01	H7173_003_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, Select Care Drugs												
H7173	003	0	1	01	01	H7173_003_0	7	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												
H7173	007	0	1	01	01	H7173_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	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 Drug, Specialty Tier, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_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																			16.00	32.00	48.00																16.00				16.00		0.53			0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_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	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 Drug, Specialty Tier, Select Care Drugs												
H7173	007	0	1	01	01	H7173_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		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 Drug, Specialty Tier, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_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, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_0	7	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												
H7220	004	0	1	02	01	H7220_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	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, Select Care Drugs												
H7220	004	0	1	02	01	H7220_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	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										1		
H7220	004	0	1	02	01	H7220_004_0	6	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	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	111		01	111		1	30	60	90				2	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												
H7220	004	0	1	02	01	H7220_004_0	6	Non-Preferred Brand	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	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	111		01	111		1	30	60	90				1	2	30	60	90				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												
H7220	009	1	1	01	01	H7220_009_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																			6.00	12.00	0.00																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	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	0.00																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	4	Preferred Brand	4	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4	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	4	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												
H7220	009	2	1	01	01	H7220_009_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																			6.00	12.00	0.00																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	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	0.00																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	4	Preferred Brand	4	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4	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	4	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												
H7220	009	3	1	01	01	H7220_009_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																			6.00	12.00	0.00																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	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	0.00																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	4	Preferred Brand	4	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4	Non-Preferred Brand	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4	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	4	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												
H7245	001	0	1	01	01	H7245_001_0	11	Preferred Generic	4	11	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					4.00	8.00	8.00																15.00				15.00			0.50	0.13	0.13			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	11	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					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	001	0	1	01	01	H7245_001_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					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	11	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											90.92	35	35	35				90.92	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	11	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	002	0	1	01	01	H7245_002_0	12	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					3.00	6.00	9.00					3.00	6.00	6.00																12.00				12.00			0.40	0.10	0.10			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	002	0	1	01	01	H7245_002_0	12	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					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	12	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	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											74.46	35	35	35				74.46	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	12	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	003	0	1	01	01	H7245_003_0	12	Preferred Generic	4	11	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	12	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					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	12	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	12	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											80.41	35	35	35				80.41	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	12	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	11	Preferred Generic	4	11	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	4.00																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	11	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					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	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					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	11	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											83.78	35	35	35				83.78	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	11	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	006	0	1	01	01	H7245_006_0	11	Preferred Generic	4	11	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					4.00	8.00	8.00																15.00				15.00			0.50	0.13	0.13			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	006	0	1	01	01	H7245_006_0	11	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					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	006	0	1	01	01	H7245_006_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					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	006	0	1	01	01	H7245_006_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											98.78	34	34	34				98.78	34	34	34				34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	006	0	1	01	01	H7245_006_0	11	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												
H7284	001	0	1	04	01	H7284_001_0	6	Preferred Generic	4	11	3	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												
H7284	001	0	1	04	01	H7284_001_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_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												
H7284	002	0	1	04	01	H7284_002_0	6	Preferred Generic	4	11	3	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												
H7284	002	0	1	04	01	H7284_002_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	002	0	1	04	01	H7284_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	002	0	1	04	01	H7284_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	002	0	1	04	01	H7284_002_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												
H7301	002	0	1	04	01	H7301_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								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												
H7301	002	0	1	04	01	H7301_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								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		
H7301	002	0	1	04	01	H7301_002_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H7301	002	0	1	04	01	H7301_002_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H7301	002	0	1	04	01	H7301_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	002	0	1	04	01	H7301_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												
H7301	002	0	1	04	01	H7301_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												
H7301	006	0	1	04	01	H7301_006_0	2	Preferred Generic	4	01	1	2	1	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												
H7301	006	0	1	04	01	H7301_006_0	2	Preferred Generic	4	01	1	2	1	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		
H7301	006	0	1	04	01	H7301_006_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	2	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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	006	0	1	04	01	H7301_006_0	2	Preferred Brand	4	11	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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				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	2	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	2	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												
H7301	007	0	1	04	01	H7301_007_0	2	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		
H7301	007	0	1	04	01	H7301_007_0	2	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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	2	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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	007	0	1	04	01	H7301_007_0	2	Preferred Brand	4	11	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												
H7301	007	0	1	04	01	H7301_007_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	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												
H7301	007	0	1	04	01	H7301_007_0	2	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												
H7301	009	0	1	04	01	H7301_009_0	2	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												
H7301	009	0	1	04	01	H7301_009_0	2	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		
H7301	009	0	1	04	01	H7301_009_0	2	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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	009	0	1	04	01	H7301_009_0	2	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	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	009	0	1	04	01	H7301_009_0	2	Preferred Brand	4	11	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												
H7301	009	0	1	04	01	H7301_009_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	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												
H7301	009	0	1	04	01	H7301_009_0	2	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												
H7317	001	0	1	01	01	H7317_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	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	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												
H7317	001	0	1	01	01	H7317_001_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												
H7317	001	0	1	01	01	H7317_001_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												
H7317	001	0	1	01	01	H7317_001_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												
H7326	001	0	1	04	01	H7326_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	001	0	1	04	01	H7326_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H7326	001	0	1	04	01	H7326_001_0	4	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	001	0	1	04	01	H7326_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		94.00				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	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				44.04	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	4	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					32																										32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	002	0	1	04	01	H7326_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	002	0	1	04	01	H7326_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H7326	002	0	1	04	01	H7326_002_0	4	Generic	4	11	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		0.00				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	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		94.00				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	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				43.93	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	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												
H7404	001	0	1	04	01	H7404_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H7404	001	0	1	04	01	H7404_001_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H7404	001	0	1	04	01	H7404_001_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	001	0	1	04	01	H7404_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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												
H7404	001	0	1	04	01	H7404_001_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				616.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H7404	002	0	1	04	01	H7404_002_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H7404	002	0	1	04	01	H7404_002_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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												
H7404	002	0	1	04	01	H7404_002_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				656.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	004	0	1	04	01	H7404_004_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H7404	004	0	1	04	01	H7404_004_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H7404	004	0	1	04	01	H7404_004_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	004	0	1	04	01	H7404_004_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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												
H7404	004	0	1	04	01	H7404_004_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				656.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H7404	005	0	1	04	01	H7404_005_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H7404	005	0	1	04	01	H7404_005_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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												
H7404	005	0	1	04	01	H7404_005_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				606.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H7404	006	0	1	04	01	H7404_006_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H7404	006	0	1	04	01	H7404_006_0	4	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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												
H7404	006	0	1	04	01	H7404_006_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				656.00	27		27																										27						27			27			27								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	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	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			
H7511	002	0	1	01	01	H7511_002_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H7522	001	0	1	04	01	H7522_001_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	8	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H7522	001	0	1	04	01	H7522_001_0	8	Preferred Brand	4	10	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	50.00		100.00																					100.00																50.00				50.00		1.67						1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	8	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				176.03	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7621	001	0	1	01	01	H7621_001_0	3	Preferred Generic	4	11	3	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												
H7621	001	0	1	01	01	H7621_001_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_001_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												
H7621	002	0	1	01	01	H7621_002_0	5	Preferred Generic	4	11	3	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												
H7621	002	0	1	01	01	H7621_002_0	5	Preferred Generic	4	11	3	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		3
H7621	002	0	1	01	01	H7621_002_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7621	002	0	1	01	01	H7621_002_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		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_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		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	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 Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	4	Preferred Generic	4	11	3	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												
H7621	003	0	1	01	01	H7621_003_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_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					47.00		141.00											47.00		141.00				47.00		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_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		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_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												
H7678	001	0	1	01	01	H7678_001_0	3	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	3	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	3	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	3	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.35			1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.39	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	3	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				610.45	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7680	001	0	1	01	01	H7680_001_0	8	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				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 Drug, Specialty Tier, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	8	Generic	4	01	3	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	13.00	26.00	39.00																					26.00																13.00				13.00		0.43						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	8	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	100				1	2			100				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, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				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	8	Specialty Tier	4	10	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, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	8	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	100				1	2			100					29	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	8	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	100				1	2			100					29	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	100				1	2			100				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 Drug, Specialty Tier, Select Care Drugs												
H7680	002	0	1	01	01	H7680_002_0	8	Generic	4	01	3	2	2	1	111		01	100		1	30	60	100				1	2			100				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, Select Care Drugs												
H7680	002	0	1	01	01	H7680_002_0	8	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	100				1	2			100				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, 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	100				1	2			100				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	010		1	30								30						30		31				670.00	27																				27																	27			27								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	100				1	2			100					29	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	100				1	2			100					29	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	5	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		6.00																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	5	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		20.00																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	5	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00		82.00																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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	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												
H7728	002	0	1	04	01	H7728_002_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	5	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		6.00																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	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00		24.00																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	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	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												
H7728	004	1	1	04	01	H7728_004_1	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		6.00																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	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00		24.00																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	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	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												
H7728	004	2	1	04	01	H7728_004_2	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	7	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		8.00																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	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00		26.00																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	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	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												
H7728	005	0	1	04	01	H7728_005_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7728	006	0	1	04	01	H7728_006_0	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		8.00																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	006	0	1	04	01	H7728_006_0	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00		26.00																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	006	0	1	04	01	H7728_006_0	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	006	0	1	04	01	H7728_006_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	006	0	1	04	01	H7728_006_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												
H7728	006	0	1	04	01	H7728_006_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	006	0	1	04	01	H7728_006_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	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	12.50					0.00	0.00	0.00											5.00	10.00	12.50				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												
H7787	001	0	1	04	01	H7787_001_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	4	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											764.30	33						535.77	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7802	001	0	1	01	01	H7802_001_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	001	0	1	01	01	H7802_001_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	001	0	1	01	01	H7802_001_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	001	0	1	01	01	H7802_001_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	001	0	1	01	01	H7802_001_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	002	0	1	01	01	H7802_002_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	002	0	1	01	01	H7802_002_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	002	0	1	01	01	H7802_002_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	002	0	1	01	01	H7802_002_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	002	0	1	01	01	H7802_002_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	003	0	1	01	01	H7802_003_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	003	0	1	01	01	H7802_003_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	003	0	1	01	01	H7802_003_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	003	0	1	01	01	H7802_003_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	003	0	1	01	01	H7802_003_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	004	0	1	01	01	H7802_004_0	4	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								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												
H7802	004	0	1	01	01	H7802_004_0	4	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	9.00	18.00	27.00																																						9.00			9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	004	0	1	01	01	H7802_004_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	004	0	1	01	01	H7802_004_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7802	004	0	1	01	01	H7802_004_0	4	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7833	001	0	1	48	05	H7833_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	0.00	3.40	0.00	3.40	0.00	3.40	0.00	3.40			
H7833	001	0	1	48	05	H7833_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	0.00	8.50	0.00	8.50	0.00	8.50	0.00	8.50			
H7833	001	0	1	48	05	H7833_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																																														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	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	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	001	0	1	01	01	H7853_001_0	9	Generic	4	11	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	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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	001	0	1	01	01	H7853_001_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	001	0	1	01	01	H7853_001_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				613.00	30		30																		30		30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	002	0	1	01	01	H7853_002_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	002	0	1	01	01	H7853_002_0	9	Generic	4	11	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	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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	002	0	1	01	01	H7853_002_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	002	0	1	01	01	H7853_002_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				682.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	003	0	1	02	01	H7853_003_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	003	0	1	02	01	H7853_003_0	9	Generic	4	11	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	003	0	1	02	01	H7853_003_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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	003	0	1	02	01	H7853_003_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	003	0	1	02	01	H7853_003_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				617.00	30		30																		30		30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	004	0	1	02	01	H7853_004_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	004	0	1	02	01	H7853_004_0	9	Generic	4	11	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	004	0	1	02	01	H7853_004_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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	004	0	1	02	01	H7853_004_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	004	0	1	02	01	H7853_004_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				664.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7885	001	0	1	48	05	H7885_001_0	4	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	0.00	3.40	0.00	3.40			0.00	3.40			
H7885	001	0	1	48	05	H7885_001_0	4	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	0.00	8.50	0.00	8.50			0.00	8.50			
H7885	001	0	1	48	05	H7885_001_0	4	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	3	Generic Drugs	4	11			1	1	111		01	100		1	31	60	90				2	2			90				31		31																																														0.11						0.11	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	3.40	0.00	3.40	0.00	3.40	0.00	3.40			
H7890	001	0	1	48	05	H7890_001_0	3	Brand Drugs	4	11			2	1	111		01	100		1	31	60	90				2	2			90				31		31																																														0.27						0.27	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	8.50	0.00	8.50	0.00	8.50	0.00	8.50			
H7890	001	0	1	48	05	H7890_001_0	3	Non-Medicare Rx Drugs	4	11			3	1	111		01	100		1	31	60	90				1	2			90				31		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	0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	3	Non-Medicare OTC Drugs	4	11			4	1	111		01	100		1	31	60	90				1	2			90				31		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	0.00	0.00			
H7917	008	0	1	04	01	H7917_008_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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	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	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	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	145.00					50.00	100.00	125.00											55.00	110.00	145.00				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	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	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	145.00					50.00	100.00	125.00											55.00	110.00	145.00				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	6	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	6	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	6	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	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	6	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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	6	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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	6	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	145.00					50.00	100.00	125.00											55.00	110.00	145.00				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	6	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	145.00					50.00	100.00	125.00											55.00	110.00	145.00				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	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	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	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	7	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	185.00					65.00	130.00	165.00											70.00	140.00	185.00				65.00	130.00	165.00					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	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	013	0	1	04	01	H7917_013_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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	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	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	7	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	185.00					65.00	130.00	165.00											70.00	140.00	185.00				65.00	130.00	165.00					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	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	014	0	1	04	01	H7917_014_0	6	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	6	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	6	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	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	6	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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	6	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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	6	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	185.00					65.00	130.00	165.00											70.00	140.00	185.00				65.00	130.00	165.00					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	6	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	6	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	6	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	6	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	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	6	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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	6	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	95.00					28.00	56.00	70.00											33.00	66.00	95.00				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	6	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	185.00					65.00	130.00	165.00											70.00	140.00	185.00				65.00	130.00	165.00					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	6	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	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	7	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	35.00					10.00	10.00	10.00											15.00	30.00	35.00				10.00	10.00	10.00					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	7	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	135.00					42.00	84.00	105.00											47.00	94.00	135.00				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	7	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	135.00					42.00	84.00	105.00											47.00	94.00	135.00				42.00	84.00	105.00					47.00			47.00			1.56	1.40		1.56	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	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	194.00	285.00					92.00	184.00	225.00											97.00	194.00	285.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_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	031	0	1	04	01	H7917_031_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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	7	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	35.00					10.00	10.00	10.00											15.00	30.00	35.00				10.00	10.00	10.00					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	7	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	135.00					42.00	84.00	105.00											47.00	94.00	135.00				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	7	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	135.00					42.00	84.00	105.00											47.00	94.00	135.00				42.00	84.00	105.00					47.00			47.00			1.56	1.40		1.56	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	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	194.00	285.00					92.00	184.00	225.00											97.00	194.00	285.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_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	032	0	1	04	01	H7917_032_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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	7	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	35.00					10.00	10.00	10.00											15.00	30.00	35.00				10.00	10.00	10.00					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	7	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	135.00					42.00	84.00	105.00											47.00	94.00	135.00				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	7	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	135.00					42.00	84.00	105.00											47.00	94.00	135.00				42.00	84.00	105.00					47.00			47.00			1.56	1.40		1.56	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	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	194.00	285.00					92.00	184.00	225.00											97.00	194.00	285.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_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	033	0	1	04	01	H7917_033_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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	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	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					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	7	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	35.00					10.00	10.00	10.00											15.00	30.00	35.00				10.00	10.00	10.00					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	7	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	135.00					42.00	84.00	105.00											47.00	94.00	135.00				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	7	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	135.00					42.00	84.00	105.00											47.00	94.00	135.00				42.00	84.00	105.00					47.00			47.00			1.56	1.40		1.56	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	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	194.00	285.00					92.00	184.00	225.00											97.00	194.00	285.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_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												
H8003	001	0	1	04	01	H8003_001_0	8	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	24.00					3.00	6.00	0.00											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	8	Preferred Generic	4	11	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	0.00											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	8	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					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	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	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	8	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.66	50	50	50				87.90	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	8	Specialty Tier	4	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												
H8003	002	0	1	04	01	H8003_002_0	8	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	24.00					3.00	6.00	0.00											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	8	Preferred Generic	4	11	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	0.00											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	8	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					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	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	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	8	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.66	50	50	50				87.89	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	8	Specialty Tier	4	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												
H8003	003	0	1	04	01	H8003_003_0	8	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	24.00					3.00	6.00	0.00											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	8	Preferred Generic	4	11	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	0.00											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	8	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					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	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	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	8	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.66	50	50	50				87.90	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	8	Specialty Tier	4	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												
H8010	002	0	1	01	01	H8010_002_0	13	Preferred Generic	4	11	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												
H8010	002	0	1	01	01	H8010_002_0	13	Generic	4	11	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												
H8010	002	0	1	01	01	H8010_002_0	13	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	002	0	1	01	01	H8010_002_0	13	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												
H8010	002	0	1	01	01	H8010_002_0	13	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1397.39	30	30	30				1397.39	30	30	30						30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	003	0	1	01	01	H8010_003_0	13	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	36.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	003	0	1	01	01	H8010_003_0	13	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											4.75	25	25	25				4.18	22	22	22						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	003	0	1	01	01	H8010_003_0	13	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											49.57	25	25	25				43.62	22	22	22						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	003	0	1	01	01	H8010_003_0	13	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											42.15	25	25	25				42.15	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	003	0	1	01	01	H8010_003_0	13	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											928.88	25	25	25				928.88	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	005	0	1	01	01	H8010_005_0	13	Preferred Generic	4	11	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												
H8010	005	0	1	01	01	H8010_005_0	13	Generic	4	11	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												
H8010	005	0	1	01	01	H8010_005_0	13	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	005	0	1	01	01	H8010_005_0	13	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												
H8010	005	0	1	01	01	H8010_005_0	13	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1537.13	33	33	33				1537.13	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	008	0	1	01	01	H8010_008_0	13	Preferred Generic	4	11	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												
H8010	008	0	1	01	01	H8010_008_0	13	Generic	4	11	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												
H8010	008	0	1	01	01	H8010_008_0	13	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	008	0	1	01	01	H8010_008_0	13	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												
H8010	008	0	1	01	01	H8010_008_0	13	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											1537.13	33	33	33				1537.13	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8016	001	0	1	48	05	H8016_001_0	3	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	3.40	0.00	3.40			0.00	3.40			
H8016	001	0	1	48	05	H8016_001_0	3	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	8.50	0.00	8.50			0.00	8.50			
H8016	001	0	1	48	05	H8016_001_0	3	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	6	Generic Drugs	4	11			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	6	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	6	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	6	Generic Drugs	4	11			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	6	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	6	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	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			
H8046	001	0	1	48	05	H8046_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	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	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			
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	18.00	36.00	54.00																			18.00	36.00	45.00																18.00				18.00		0.60			0.60			0.58	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		
H8087	001	0	1	04	01	H8087_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					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												
H8087	001	0	1	04	01	H8087_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_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												
H8087	002	0	1	04	01	H8087_002_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												
H8087	002	0	1	04	01	H8087_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_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												
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				96.41	41	41	41																		41	41	41															41			41								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				557.74	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	001	0	1	01	01	H8133_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													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	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		
H8133	001	0	1	01	01	H8133_001_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												
H8133	001	0	1	01	01	H8133_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												
H8133	001	0	1	01	01	H8133_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												
H8133	001	0	1	01	01	H8133_001_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					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	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												
H8133	003	0	1	01	01	H8133_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		
H8133	003	0	1	01	01	H8133_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												
H8133	003	0	1	01	01	H8133_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												
H8133	003	0	1	01	01	H8133_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												
H8133	003	0	1	01	01	H8133_003_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					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	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												
H8133	005	0	1	01	01	H8133_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		
H8133	005	0	1	01	01	H8133_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					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	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												
H8133	005	0	1	01	01	H8133_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												
H8133	005	0	1	01	01	H8133_005_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					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	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												
H8133	007	0	1	01	01	H8133_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		
H8133	007	0	1	01	01	H8133_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												
H8133	007	0	1	01	01	H8133_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												
H8133	007	0	1	01	01	H8133_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												
H8133	007	0	1	01	01	H8133_007_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	5	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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 Drug, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	5	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	40.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	5	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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												
H8142	001	0	1	01	01	H8142_001_0	5	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	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												
H8142	001	0	1	01	01	H8142_001_0	5	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												
H8142	002	0	1	01	01	H8142_002_0	4	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	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 Drug, Specialty Tier												
H8142	002	0	1	01	01	H8142_002_0	4	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	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												
H8142	002	0	1	01	01	H8142_002_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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												
H8142	002	0	1	01	01	H8142_002_0	4	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	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												
H8142	002	0	1	01	01	H8142_002_0	4	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												
H8142	003	0	1	01	01	H8142_003_0	4	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	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												
H8142	003	0	1	01	01	H8142_003_0	4	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	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		
H8142	003	0	1	01	01	H8142_003_0	4	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	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												
H8142	003	0	1	01	01	H8142_003_0	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		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												
H8142	003	0	1	01	01	H8142_003_0	4	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	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												
H8142	003	0	1	01	01	H8142_003_0	4	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												
H8145	003	0	1	09	04	H8145_003_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												
H8145	003	0	1	09	04	H8145_003_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	003	0	1	09	04	H8145_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_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												
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					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	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					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	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	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					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	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												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_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												
H8145	006	0	1	09	04	H8145_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_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												
H8145	008	0	1	09	04	H8145_008_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												
H8145	008	0	1	09	04	H8145_008_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_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												
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	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	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	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	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												
H8145	021	0	1	09	04	H8145_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_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												
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	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	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	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	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												
H8145	051	0	1	09	04	H8145_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	051	0	1	09	04	H8145_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	051	0	1	09	04	H8145_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	051	0	1	09	04	H8145_051_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												
H8145	052	0	1	09	04	H8145_052_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	052	0	1	09	04	H8145_052_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	5	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	061	0	1	09	04	H8145_061_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	061	0	1	09	04	H8145_061_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_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	063	0	1	09	04	H8145_063_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												
H8145	063	0	1	09	04	H8145_063_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_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	069	0	1	09	04	H8145_069_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	069	0	1	09	04	H8145_069_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_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												
H8145	075	0	1	09	04	H8145_075_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					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												
H8145	075	0	1	09	04	H8145_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_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												
H8145	084	0	1	09	04	H8145_084_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												
H8145	084	0	1	09	04	H8145_084_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_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	087	0	1	09	04	H8145_087_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					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												
H8145	087	0	1	09	04	H8145_087_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					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_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	089	0	1	09	04	H8145_089_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					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												
H8145	089	0	1	09	04	H8145_089_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_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												
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	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	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	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	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	103	0	1	09	04	H8145_103_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_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	122	0	1	09	04	H8145_122_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												
H8145	122	0	1	09	04	H8145_122_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_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												
H8145	123	0	1	09	04	H8145_123_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	123	0	1	09	04	H8145_123_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_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												
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	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	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	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	12	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	001	0	1	01	01	H8170_001_0	12	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	001	0	1	01	01	H8170_001_0	12	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	001	0	1	01	01	H8170_001_0	12	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	12	Preferred Generic	4	11	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	002	0	1	01	01	H8170_002_0	12	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	002	0	1	01	01	H8170_002_0	12	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	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	002	0	1	01	01	H8170_002_0	12	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	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												
H8189	001	0	1	01	01	H8189_001_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																			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	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												
H8189	001	0	1	01	01	H8189_001_0	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												
H8189	001	0	1	01	01	H8189_001_0	5	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												
H8189	001	0	1	01	01	H8189_001_0	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												
H8197	001	0	1	48	05	H8197_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			
H8197	001	0	1	48	05	H8197_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	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	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			
H8211	001	0	1	04	01	H8211_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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				2	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				2	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				2	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				2	2						90	30		31				805.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				912.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				805.00	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				2	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				2	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				2	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				2	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				2	2						90	30		31				963.00	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	7	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			
H8213	001	0	1	48	05	H8213_001_0	7	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/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	7	Non-Medicare Rx/OTC Drugs	4	10			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			
H8258	001	0	1	48	05	H8258_001_0	5	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	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	5	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	0.00	8.50			0.00	8.50	0.00	8.50			
H8258	001	0	1	48	05	H8258_001_0	5	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	5	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	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8266	001	0	1	01	01	H8266_001_0	4	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																					141.00																47.00				47.00		1.57						1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	4	Specialty Tier	4	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				2153.35	33	33	33																				33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8266	002	0	1	01	01	H8266_002_0	4	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																					141.00																47.00				47.00		1.57						1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	4	Non-Preferred Brand	4	10	3	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	85.00	170.00	255.00																					255.00																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	4	Specialty Tier	4	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				2406.42	33	33	33																				33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	004	0	1	01	01	H8266_004_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	004	0	1	01	01	H8266_004_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8266	004	0	1	01	01	H8266_004_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	004	0	1	01	01	H8266_004_0	4	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	004	0	1	01	01	H8266_004_0	4	Specialty Tier	4	11	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				2142.80	33	33	33																				33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8280	001	0	1	01	01	H8280_001_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	001	0	1	01	01	H8280_001_0	9	Generic	4	11	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												
H8280	001	0	1	01	01	H8280_001_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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	001	0	1	01	01	H8280_001_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	001	0	1	01	01	H8280_001_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				659.00	32		32																		32		32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	002	0	1	01	01	H8280_002_0	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	002	0	1	01	01	H8280_002_0	11	Generic	4	11	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												
H8280	002	0	1	01	01	H8280_002_0	11	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 Drug, Specialty Tier												
H8280	002	0	1	01	01	H8280_002_0	11	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	002	0	1	01	01	H8280_002_0	11	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				669.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	003	0	1	02	01	H8280_003_0	9	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	003	0	1	02	01	H8280_003_0	9	Generic	4	11	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												
H8280	003	0	1	02	01	H8280_003_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				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	003	0	1	02	01	H8280_003_0	9	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	003	0	1	02	01	H8280_003_0	9	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				656.00	32		32																		32		32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	004	0	1	02	01	H8280_004_0	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	004	0	1	02	01	H8280_004_0	11	Generic	4	11	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												
H8280	004	0	1	02	01	H8280_004_0	11	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 Drug, Specialty Tier												
H8280	004	0	1	02	01	H8280_004_0	11	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8280	004	0	1	02	01	H8280_004_0	11	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				666.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8423	001	0	1	48	05	H8423_001_0	8	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	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	8	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	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	5	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	5	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								12.00	24.00	36.00					12.00	24.00	36.00					12.00		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												
H8432	002	0	1	01	01	H8432_002_0	5	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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	002	0	1	01	01	H8432_002_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	5	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H8432	005	0	1	02	01	H8432_005_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H8432	006	0	1	02	01	H8432_006_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	4	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	4	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00		42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	007	0	1	01	01	H8432_007_0	4	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	4	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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	007	0	1	01	01	H8432_007_0	4	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	4	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	5	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		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	5	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	5	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00		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	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	008	5	1	01	01	H8432_008_5	5	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	5	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	5	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		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	5	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	5	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00		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	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	008	6	1	01	01	H8432_008_6	5	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	5	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	5	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		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	5	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	5	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00		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	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	008	7	1	01	01	H8432_008_7	5	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	5	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H8432	009	0	1	01	01	H8432_009_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00		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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H8432	010	0	1	01	01	H8432_010_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H8432	011	0	1	01	01	H8432_011_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	5	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	5	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	5	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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	013	0	1	01	01	H8432_013_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	5	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H8432	014	0	1	02	01	H8432_014_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	5	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		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	5	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	5	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								98.00	196.00	294.00					93.00	186.00	279.00					93.00		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	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	015	0	1	02	01	H8432_015_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	5	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H8432	016	0	1	01	01	H8432_016_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00		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	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H8432	017	0	1	01	01	H8432_017_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	5	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	5	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00		42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	018	0	1	01	01	H8432_018_0	5	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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	018	0	1	01	01	H8432_018_0	5	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	5	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	027	0	1	01	01	H8432_027_0	6	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		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	027	0	1	01	01	H8432_027_0	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	027	0	1	01	01	H8432_027_0	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	027	0	1	01	01	H8432_027_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00		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	027	0	1	01	01	H8432_027_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												
H8432	027	0	1	01	01	H8432_027_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	027	0	1	01	01	H8432_027_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	028	0	1	01	01	H8432_028_0	7	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	028	0	1	01	01	H8432_028_0	7	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00		42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	028	0	1	01	01	H8432_028_0	7	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	028	0	1	01	01	H8432_028_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	028	0	1	01	01	H8432_028_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												
H8432	028	0	1	01	01	H8432_028_0	7	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	028	0	1	01	01	H8432_028_0	7	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	031	1	1	01	01	H8432_031_1	5	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	031	1	1	01	01	H8432_031_1	5	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00		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	031	1	1	01	01	H8432_031_1	5	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	031	1	1	01	01	H8432_031_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	031	1	1	01	01	H8432_031_1	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	031	1	1	01	01	H8432_031_1	5	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	031	1	1	01	01	H8432_031_1	5	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	031	2	1	01	01	H8432_031_2	6	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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	031	2	1	01	01	H8432_031_2	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00		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	031	2	1	01	01	H8432_031_2	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	031	2	1	01	01	H8432_031_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	031	2	1	01	01	H8432_031_2	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	031	2	1	01	01	H8432_031_2	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	031	2	1	01	01	H8432_031_2	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	032	0	1	01	01	H8432_032_0	6	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		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	032	0	1	01	01	H8432_032_0	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	032	0	1	01	01	H8432_032_0	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	032	0	1	01	01	H8432_032_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00		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	032	0	1	01	01	H8432_032_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												
H8432	032	0	1	01	01	H8432_032_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	032	0	1	01	01	H8432_032_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	033	0	1	01	01	H8432_033_0	6	Preferred Generic	4	01	3	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00		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	033	0	1	01	01	H8432_033_0	6	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		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	033	0	1	01	01	H8432_033_0	6	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	033	0	1	01	01	H8432_033_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00		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	033	0	1	01	01	H8432_033_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												
H8432	033	0	1	01	01	H8432_033_0	6	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	033	0	1	01	01	H8432_033_0	6	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	9	Generic Drugs	4	11			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			
H8452	001	0	1	48	05	H8452_001_0	9	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	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	9	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	6	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	6	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	6	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	6	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												
H8506	003	0	1	01	01	H8506_003_0	11	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												
H8506	003	0	1	01	01	H8506_003_0	11	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												
H8506	003	0	1	01	01	H8506_003_0	11	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	003	0	1	01	01	H8506_003_0	11	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												
H8506	003	0	1	01	01	H8506_003_0	11	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	10	Preferred Generic	3	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00		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												
H8552	020	0	1	04	01	H8552_020_0	10	Generic	3	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00		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												
H8552	020	0	1	04	01	H8552_020_0	10	Preferred Brand	3	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	10	Non-Preferred Drug	3	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	10	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	10	Select Care Drugs	3	01	1	2	6	1		111	01	110		1				30	60	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	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	8	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00		3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	028	0	1	04	01	H8552_028_0	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								11.00	22.00	33.00					6.00	12.00	18.00					6.00		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												
H8552	028	0	1	04	01	H8552_028_0	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		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	8	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	8	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												
H8552	028	0	1	04	01	H8552_028_0	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	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												
H8554	001	0	1	01	01	H8554_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													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	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												
H8554	001	0	1	01	01	H8554_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												
H8554	001	0	1	01	01	H8554_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												
H8554	001	0	1	01	01	H8554_001_0	7	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					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	7	Preferred Generic	4	11	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	7	Preferred Generic	4	11	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	7	Generic	4	11	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	7	Preferred Brand	4	11	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	7	Non-Preferred Brand	4	11	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	7	Specialty Tier	4	11	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	7	Preferred Generic	4	11	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	7	Generic	4	11	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	7	Preferred Brand	4	11	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	7	Non-Preferred Brand	4	11	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	7	Specialty Tier	4	11	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	7	Preferred Generic	4	11	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	7	Generic	4	11	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	7	Preferred Brand	4	11	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	7	Non-Preferred Brand	4	11	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	7	Specialty Tier	4	11	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												
H8578	016	0	1	02	01	H8578_016_0	7	Preferred Generic	4	11	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	016	0	1	02	01	H8578_016_0	7	Generic	4	11	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	016	0	1	02	01	H8578_016_0	7	Preferred Brand	4	11	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	016	0	1	02	01	H8578_016_0	7	Non-Preferred Brand	4	11	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	016	0	1	02	01	H8578_016_0	7	Specialty Tier	4	11	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												
H8604	010	0	1	04	01	H8604_010_0	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	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	4	Specialty Tier	4	11	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	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	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	4	Specialty Tier	4	11	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	4	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	4	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	4	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	4	Non-Preferred Drug	4	11	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	4	Specialty Tier	4	11	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	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												25		25					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								8.00		24.00					3.00		0.00													24.00						0.00				8.00				8.00			0.27	0.10				0.26	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								8.00		24.00					3.00		0.00													24.00						0.00				8.00				8.00			0.27	0.10				0.26	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	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												25		25					25		25												25						25			25			25								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	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												33		33					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	3	Preferred Generic	4	01	1	2	1	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												
H8649	003	0	1	01	01	H8649_003_0	3	Preferred Generic	4	01	1	2	1	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		
H8649	003	0	1	01	01	H8649_003_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8649	003	0	1	01	01	H8649_003_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_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												
H8649	003	0	1	01	01	H8649_003_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												
H8649	008	0	1	01	01	H8649_008_0	2	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	2	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	2	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	0.00																			7.00	14.00	0.00																	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	2	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	0.00																			7.00	14.00	0.00																	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	2	Preferred Brand	4	11	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	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	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	2	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												
H8677	001	0	1	48	05	H8677_001_0	2	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	2	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	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	2	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	2	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	2	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	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	2	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				2	2						90	30		31	3.00		6.00																											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				2	2						90	30		31	12.00		24.00																											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				2	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				2	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				2	2						90	30		31				1154.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	02	01	H8748_008_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				910.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	02	01	H8748_009_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1020.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	010	0	1	02	01	H8748_010_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				908.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	011	0	1	02	01	H8748_011_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1031.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	012	0	1	01	01	H8748_012_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1276.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	013	0	1	01	01	H8748_013_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1168.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	014	0	1	01	01	H8748_014_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1088.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				941.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	017	0	1	01	01	H8748_017_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1147.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	018	0	1	01	01	H8748_018_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				919.00	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				2	2						90	30		31	3.00		6.00																											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				2	2						90	30		31	12.00		24.00																											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				2	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				2	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				2	2						90	30		31				1204.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	022	0	1	02	01	H8748_022_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				938.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	023	0	1	02	01	H8748_023_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1031.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	11	Preferred Generic	4	01	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		.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	11	Preferred Generic	4	01	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										1		
H8764	001	0	1	01	01	H8764_001_0	11	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												
H8764	001	0	1	01	01	H8764_001_0	11	Generic	4	01	1	2	2	3	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										1		
H8764	001	0	1	01	01	H8764_001_0	11	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												
H8764	001	0	1	01	01	H8764_001_0	11	Non-Preferred Drug	4	10	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												
H8764	001	0	1	01	01	H8764_001_0	11	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 Drug, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	11	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												
H8764	002	0	1	02	01	H8764_002_0	11	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		
H8764	002	0	1	02	01	H8764_002_0	11	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												
H8764	002	0	1	02	01	H8764_002_0	11	Generic	4	01	1	2	2	3	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										1		
H8764	002	0	1	02	01	H8764_002_0	11	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	42.00		126.00																					84.00																42.00				42.00		1.40						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	11	Non-Preferred Drug	4	10	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												
H8764	002	0	1	02	01	H8764_002_0	11	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												
H8764	003	0	1	01	01	H8764_003_0	11	Preferred Generic	3	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												
H8764	003	0	1	01	01	H8764_003_0	11	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	11	Preferred Brand	3	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	11	Non-Preferred Drug	3	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	11	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 Drug, Specialty Tier												
H8768	001	0	1	04	01	H8768_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				999.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				962.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1190.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				1190.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	005	0	1	04	01	H8768_005_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	005	0	1	04	01	H8768_005_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	005	0	1	04	01	H8768_005_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	005	0	1	04	01	H8768_005_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				857.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	006	0	1	04	01	H8768_006_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H8768	006	0	1	04	01	H8768_006_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H8768	006	0	1	04	01	H8768_006_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	006	0	1	04	01	H8768_006_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	006	0	1	04	01	H8768_006_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				906.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	007	0	1	04	01	H8768_007_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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												
H8768	007	0	1	04	01	H8768_007_0	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H8768	007	0	1	04	01	H8768_007_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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	007	0	1	04	01	H8768_007_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	007	0	1	04	01	H8768_007_0	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				797.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	008	0	1	04	01	H8768_008_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	008	0	1	04	01	H8768_008_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H8768	008	0	1	04	01	H8768_008_0	3	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	008	0	1	04	01	H8768_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	008	0	1	04	01	H8768_008_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				946.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	009	0	1	04	01	H8768_009_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	009	0	1	04	01	H8768_009_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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												
H8768	009	0	1	04	01	H8768_009_0	3	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						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	009	0	1	04	01	H8768_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	009	0	1	04	01	H8768_009_0	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				900.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	6	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								8.00		24.00					1.00		3.00											8.00		16.00				1.00		2.00					8.00			8.00			0.27	0.03		0.27	0.03	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	6	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								17.00		51.00					10.00		30.00											17.00		34.00				10.00		20.00					17.00			17.00			0.57	0.33		0.57	0.33	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	6	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					40.00		120.00											47.00		94.00				40.00		80.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											71.73	50		50				64.56	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	6	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1701.75	25		25				1701.75	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	5	Preferred Generic	4	01	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								8.00		24.00					1.00		3.00											8.00		16.00				1.00		2.00					8.00			8.00			0.27	0.03		0.27	0.03	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	5	Generic	4	01	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								14.00		42.00					7.00		21.00											14.00		28.00				7.00		14.00					14.00			14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	5	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								42.00		126.00					35.00		105.00											42.00		84.00				35.00		70.00					42.00			42.00			1.40	1.17		1.40	1.17	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											80.30	50		50				72.27	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	5	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2259.23	28		28				2259.23	28		28										28		28				28		28				28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8786	001	0	1	48	05	H8786_001_0	4	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	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	4	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	0.00	8.50			0.00	8.50	0.00	8.50			
H8786	001	0	1	48	05	H8786_001_0	4	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	4	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	6	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	6	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	6	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	6	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			
H8889	001	0	1	04	01	H8889_001_0	7	Preferred Generic	3	11	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												
H8889	001	0	1	04	01	H8889_001_0	7	Generic	3	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					0.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	001	0	1	04	01	H8889_001_0	7	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	46.00		138.00																					92.00																46.00				46.00		1.53						1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	001	0	1	04	01	H8889_001_0	7	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				88.79	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	001	0	1	04	01	H8889_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												
H8889	002	0	1	04	01	H8889_002_0	6	Preferred Generic	3	11	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												
H8889	002	0	1	04	01	H8889_002_0	6	Generic	3	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					0.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	6	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	46.00		138.00																					92.00																46.00				46.00		1.53						1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	6	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				90.04	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	6	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												
H8889	003	0	1	04	01	H8889_003_0	6	Preferred Generic	3	11	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												
H8889	003	0	1	04	01	H8889_003_0	6	Generic	3	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					0.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	6	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	44.00		132.00																					88.00																44.00				44.00		1.47						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	6	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				70.97	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	6	Specialty Tier	3	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 Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	6	Preferred Generic	3	11	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												
H8889	004	0	1	04	01	H8889_004_0	6	Generic	3	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					0.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	6	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	44.00		132.00																					88.00																44.00				44.00		1.47						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	6	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				91.76	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	6	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												
H8908	001	0	1	01	01	H8908_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					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												
H8908	001	0	1	01	01	H8908_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_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												
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	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	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	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	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												
H8908	004	0	1	01	01	H8908_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	01	01	H8908_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	01	01	H8908_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	01	01	H8908_004_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												
H8908	005	0	1	01	01	H8908_005_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												
H8908	005	0	1	01	01	H8908_005_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	005	0	1	01	01	H8908_005_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	005	0	1	01	01	H8908_005_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	005	0	1	01	01	H8908_005_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												
H9001	013	0	1	02	01	H9001_013_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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	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											12.00	24.00	24.00				7.00	14.00	14.00				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	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											42.00	84.00	84.00				37.00	74.00	74.00				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	4	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	182.00				86.00	172.00	172.00				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	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 Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	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											12.00	24.00	24.00				7.00	14.00	14.00				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	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											42.00	84.00	84.00				37.00	74.00	74.00				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	4	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	182.00				86.00	172.00	172.00				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	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 Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	5	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	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											12.00	24.00	24.00				7.00	14.00	14.00				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	84.00				37.00	74.00	74.00				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	182.00				86.00	172.00	172.00				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	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	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											12.00	24.00	24.00				7.00	14.00	14.00				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	84.00				37.00	74.00	74.00				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	182.00				86.00	172.00	172.00				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	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	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											12.00	24.00	24.00				7.00	14.00	14.00				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	84.00				37.00	74.00	74.00				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	182.00				86.00	172.00	172.00				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	030	8	1	01	01	H9001_030_8	5	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	8	1	01	01	H9001_030_8	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	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				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	8	1	01	01	H9001_030_8	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	84.00				37.00	74.00	74.00				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	8	1	01	01	H9001_030_8	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	182.00				86.00	172.00	172.00				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	8	1	01	01	H9001_030_8	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	9	1	01	01	H9001_030_9	5	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	9	1	01	01	H9001_030_9	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	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				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	9	1	01	01	H9001_030_9	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	84.00				37.00	74.00	74.00				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	9	1	01	01	H9001_030_9	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	182.00				86.00	172.00	172.00				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	9	1	01	01	H9001_030_9	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	4	1	01	01	H9001_031_4	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	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											12.00	24.00	24.00				7.00	14.00	14.00				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	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											42.00	84.00	84.00				37.00	74.00	74.00				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	4	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	182.00				86.00	172.00	172.00				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	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 Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	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											12.00	24.00	24.00				7.00	14.00	14.00				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	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											42.00	84.00	84.00				37.00	74.00	74.00				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	4	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	182.00				86.00	172.00	172.00				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	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 Brand, Specialty Tier												
H9001	031	7	1	01	01	H9001_031_7	6	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	6	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											12.00	24.00	24.00				7.00	14.00	14.00				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	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	84.00				37.00	74.00	74.00				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	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	182.00				86.00	172.00	172.00				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	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	031	8	1	01	01	H9001_031_8	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	8	1	01	01	H9001_031_8	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											12.00	24.00	24.00				7.00	14.00	14.00				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	8	1	01	01	H9001_031_8	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											42.00	84.00	84.00				37.00	74.00	74.00				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	8	1	01	01	H9001_031_8	4	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	182.00				86.00	172.00	172.00				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	8	1	01	01	H9001_031_8	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 Brand, Specialty Tier												
H9001	031	9	1	01	01	H9001_031_9	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	9	1	01	01	H9001_031_9	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											12.00	24.00	24.00				7.00	14.00	14.00				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	9	1	01	01	H9001_031_9	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											42.00	84.00	84.00				37.00	74.00	74.00				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	9	1	01	01	H9001_031_9	4	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	182.00				86.00	172.00	172.00				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	9	1	01	01	H9001_031_9	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 Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	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	21.00					2.00	4.00	6.00											7.00	14.00	14.00				2.00	4.00	4.00				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	5	Generic	4	11	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	28.00				9.00	18.00	18.00				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	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	94.00				42.00	84.00	84.00				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	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	200.00				95.00	190.00	190.00				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	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	5	1	01	01	H9001_032_5	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	21.00					2.00	4.00	6.00											7.00	14.00	14.00				2.00	4.00	4.00				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	11	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	28.00				9.00	18.00	18.00				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	94.00				42.00	84.00	84.00				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	200.00				95.00	190.00	190.00				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	11	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	14.00				2.00	4.00	4.00				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	11	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	28.00				9.00	18.00	18.00				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	94.00				42.00	84.00	84.00				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	200.00				95.00	190.00	190.00				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	11	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	14.00				2.00	4.00	4.00				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	11	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	28.00				9.00	18.00	18.00				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	94.00				42.00	84.00	84.00				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	200.00				95.00	190.00	190.00				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	032	8	1	01	01	H9001_032_8	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	21.00					2.00	4.00	6.00											7.00	14.00	14.00				2.00	4.00	4.00				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	8	1	01	01	H9001_032_8	5	Generic	4	11	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	28.00				9.00	18.00	18.00				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	8	1	01	01	H9001_032_8	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	94.00				42.00	84.00	84.00				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	8	1	01	01	H9001_032_8	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	200.00				95.00	190.00	190.00				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	8	1	01	01	H9001_032_8	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	9	1	01	01	H9001_032_9	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	21.00					2.00	4.00	6.00											7.00	14.00	14.00				2.00	4.00	4.00				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	9	1	01	01	H9001_032_9	5	Generic	4	11	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	28.00				9.00	18.00	18.00				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	9	1	01	01	H9001_032_9	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	94.00				42.00	84.00	84.00				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	9	1	01	01	H9001_032_9	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	200.00				95.00	190.00	190.00				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	9	1	01	01	H9001_032_9	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	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	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											12.00	24.00	24.00				7.00	14.00	14.00				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	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											42.00	84.00	84.00				37.00	74.00	74.00				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	4	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	182.00				86.00	172.00	172.00				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	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 Brand, Specialty Tier												
H9001	034	5	1	01	01	H9001_034_5	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	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											12.00	24.00	24.00				7.00	14.00	14.00				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	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											42.00	84.00	84.00				37.00	74.00	74.00				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	4	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	182.00				86.00	172.00	172.00				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	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 Brand, Specialty Tier												
H9001	034	6	1	01	01	H9001_034_6	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	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											12.00	24.00	24.00				7.00	14.00	14.00				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	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											42.00	84.00	84.00				37.00	74.00	74.00				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	4	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	182.00				86.00	172.00	172.00				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	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 Brand, Specialty Tier												
H9001	034	8	1	01	01	H9001_034_8	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	8	1	01	01	H9001_034_8	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											12.00	24.00	24.00				7.00	14.00	14.00				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	8	1	01	01	H9001_034_8	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											42.00	84.00	84.00				37.00	74.00	74.00				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	8	1	01	01	H9001_034_8	4	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	182.00				86.00	172.00	172.00				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	8	1	01	01	H9001_034_8	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 Brand, Specialty Tier												
H9001	034	9	1	01	01	H9001_034_9	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					1.00	2.00	3.00											6.00	12.00	12.00				1.00	2.00	2.00				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	9	1	01	01	H9001_034_9	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											12.00	24.00	24.00				7.00	14.00	14.00				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	9	1	01	01	H9001_034_9	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											42.00	84.00	84.00				37.00	74.00	74.00				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	9	1	01	01	H9001_034_9	4	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	182.00				86.00	172.00	172.00				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	9	1	01	01	H9001_034_9	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 Brand, Specialty Tier												
H9003	001	0	1	01	01	H9003_001_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	001	0	1	01	01	H9003_001_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	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, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	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, Vaccines										1		
H9003	001	0	1	01	01	H9003_001_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	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 Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_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	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, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	6	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				1837.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_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												
H9003	001	0	1	01	01	H9003_001_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		
H9003	006	0	1	01	01	H9003_006_0	6	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	6	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	6	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	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, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	6	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	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, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	6	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	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 Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_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	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, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	6	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				1654.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_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												
H9003	006	0	1	01	01	H9003_006_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		
H9047	001	0	1	01	01	H9047_001_0	6	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					4.00	8.00	9.60					4.00	8.00	9.60																12.00				12.00			0.40	0.13	0.13			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	6	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	001	0	1	01	01	H9047_001_0	6	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	001	0	1	01	01	H9047_001_0	6	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					90.00	180.00	216.00					90.00	180.00	216.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1900.23	33						1900.23	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	7	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					4.00	8.00	9.60					4.00	8.00	9.60																12.00				12.00			0.40	0.13	0.13			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	7	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	013	0	2	01	01	H9047_013_0	7	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	013	0	2	01	01	H9047_013_0	7	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					90.00	180.00	216.00					90.00	180.00	216.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											2445.14	33						2445.14	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	6	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					4.00	8.00	9.60					4.00	8.00	9.60																14.00				14.00			0.47	0.13	0.13			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	6	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					13.00	26.00	31.20					13.00	26.00	31.20																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	6	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	6	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	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1947.89	28						1947.89	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	01	01	H9047_037_0	6	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					0.00	0.00	0.00					0.00	0.00	0.00																16.00				16.00			0.53	0.00	0.00			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	01	01	H9047_037_0	6	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	24.00					10.00	20.00	24.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	01	01	H9047_037_0	6	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	01	01	H9047_037_0	6	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	01	01	H9047_037_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											2131.53	27						2131.53	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	6	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	6	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					10.00	20.00	24.00					10.00	20.00	24.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	6	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	038	0	1	02	01	H9047_038_0	6	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					90.00	180.00	216.00					90.00	180.00	216.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											2139.29	33						2139.29	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	6	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					5.00	10.00	12.00					5.00	10.00	12.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	6	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	039	0	1	02	01	H9047_039_0	6	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	6	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	039	0	1	02	01	H9047_039_0	6	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1514.59	27						1514.59	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	045	0	1	01	01	H9047_045_0	6	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	6	Generic	3	01	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	045	0	1	01	01	H9047_045_0	6	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	6	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	6	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											1801.87	28						1801.87	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	047	0	1	02	01	H9047_047_0	7	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					4.00	8.00	9.60					4.00	8.00	9.60																14.00				14.00			0.47	0.13	0.13			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	047	0	1	02	01	H9047_047_0	7	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					13.00	26.00	31.20					13.00	26.00	31.20																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	047	0	1	02	01	H9047_047_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1755.31	28						1755.31	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	049	0	1	01	01	H9047_049_0	7	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					0.00	0.00	0.00					0.00	0.00	0.00																16.00				16.00			0.53	0.00	0.00			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	049	0	1	01	01	H9047_049_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	24.00					10.00	20.00	24.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	049	0	1	01	01	H9047_049_0	7	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	7	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	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1879.84	27						1879.84	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	054	0	1	01	01	H9047_054_0	7	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					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 Drug, Specialty Tier												
H9047	054	0	1	01	01	H9047_054_0	7	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	24.00					10.00	20.00	24.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	054	0	1	01	01	H9047_054_0	7	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	054	0	1	01	01	H9047_054_0	7	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	054	0	1	01	01	H9047_054_0	7	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1785.35	27						1785.35	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	001	0	1	04	01	H9070_001_0	3	Preferred Generic	4	11	3	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												
H9070	001	0	1	04	01	H9070_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	001	0	1	04	01	H9070_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	001	0	1	04	01	H9070_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	001	0	1	04	01	H9070_001_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												
H9070	002	0	1	04	01	H9070_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												
H9070	002	0	1	04	01	H9070_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	002	0	1	04	01	H9070_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	002	0	1	04	01	H9070_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	002	0	1	04	01	H9070_002_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												
H9082	007	0	1	01	01	H9082_007_0	4	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	4	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	4	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	44.00	88.00	132.00																			44.00	88.00	132.00																44.00				44.00		1.42			1.42			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	007	0	1	01	01	H9082_007_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				99.22	44	44	44																		44	44	44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	007	0	1	01	01	H9082_007_0	4	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				615.53	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9096	001	0	1	01	01	H9096_001_0	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	Preferred Generic	3	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	9.00	18.00	18.00																			9.00	18.00	18.00																	9.00			9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	004	0	1	01	01	H9096_004_0	7	Generic	3	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	20.00	40.00	40.00																			20.00	40.00	40.00																	20.00			20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	004	0	1	01	01	H9096_004_0	7	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	7	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	7	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	7	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	7	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	7	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	7	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	7	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	006	0	1	01	01	H9096_006_0	7	Preferred Generic	3	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	9.00	18.00	18.00																			9.00	18.00	18.00																	9.00			9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	006	0	1	01	01	H9096_006_0	7	Generic	3	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	20.00	40.00	40.00																			20.00	40.00	40.00																	20.00			20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	006	0	1	01	01	H9096_006_0	7	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	006	0	1	01	01	H9096_006_0	7	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	006	0	1	01	01	H9096_006_0	7	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	007	0	1	01	01	H9096_007_0	7	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	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 Brand, Specialty Tier												
H9096	007	0	1	01	01	H9096_007_0	7	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	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 Brand, Specialty Tier												
H9096	007	0	1	01	01	H9096_007_0	7	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	007	0	1	01	01	H9096_007_0	7	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	007	0	1	01	01	H9096_007_0	7	Specialty Tier	4	10	1	1	5	1	010		10			1	30															29	31					27																																						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	008	0	1	01	01	H9096_008_0	7	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	008	0	1	01	01	H9096_008_0	7	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	9.00	18.00	18.00																			9.00	18.00	18.00																	9.00			9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	008	0	1	01	01	H9096_008_0	7	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	008	0	1	01	01	H9096_008_0	7	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	008	0	1	01	01	H9096_008_0	7	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	009	0	1	01	01	H9096_009_0	7	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	009	0	1	01	01	H9096_009_0	7	Generic	4	01	1	2	2	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	009	0	1	01	01	H9096_009_0	7	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	009	0	1	01	01	H9096_009_0	7	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	009	0	1	01	01	H9096_009_0	7	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	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	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 Drug, Specialty Tier												
H9104	006	0	1	01	01	H9104_006_0	5	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	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 Drug, Specialty Tier										1		
H9104	006	0	1	01	01	H9104_006_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	36.00					5.00	10.00	15.00					5.00	10.00	0.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9104	006	0	1	01	01	H9104_006_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					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	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					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	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												
H9190	001	0	1	01	01	H9190_001_0	13	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												
H9190	001	0	1	01	01	H9190_001_0	13	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		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9190	001	0	1	01	01	H9190_001_0	13	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												
H9190	001	0	1	01	01	H9190_001_0	13	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												
H9190	001	0	1	01	01	H9190_001_0	13	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				554.78	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9190	002	0	1	01	01	H9190_002_0	12	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												
H9190	002	0	1	01	01	H9190_002_0	12	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		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9190	002	0	1	01	01	H9190_002_0	12	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												
H9190	002	0	1	01	01	H9190_002_0	12	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												
H9190	002	0	1	01	01	H9190_002_0	12	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				650.56	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9190	007	0	1	01	01	H9190_007_0	16	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												
H9190	007	0	1	01	01	H9190_007_0	16	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		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9190	007	0	1	01	01	H9190_007_0	16	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												
H9190	007	0	1	01	01	H9190_007_0	16	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												
H9190	007	0	1	01	01	H9190_007_0	16	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				608.73	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9190	008	0	1	01	01	H9190_008_0	13	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												
H9190	008	0	1	01	01	H9190_008_0	13	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		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9190	008	0	1	01	01	H9190_008_0	13	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												
H9190	008	0	1	01	01	H9190_008_0	13	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												
H9190	008	0	1	01	01	H9190_008_0	13	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				578.91	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	002	0	1	01	01	H9207_002_0	12	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	12	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	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	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	12	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				105.79	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	002	0	1	01	01	H9207_002_0	12	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1244.47	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				104.21	25	25	25																				25															25			25								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				1646.34	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	010	0	1	01	01	H9207_010_0	10	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	10	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	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	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	10	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				108.93	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	010	0	1	01	01	H9207_010_0	10	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1272.73	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9276	002	0	1	01	01	H9276_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	002	0	1	01	01	H9276_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								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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	002	0	1	01	01	H9276_002_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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	002	0	1	01	01	H9276_002_0	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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9276	002	0	1	01	01	H9276_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					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, Select Care Drugs												
H9276	002	0	1	01	01	H9276_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	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 Drug, Specialty Tier, Select Care Drugs												
H9276	002	0	1	01	01	H9276_002_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, Select Care Drugs												
H9276	002	0	1	01	01	H9276_002_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	002	0	1	01	01	H9276_002_0	5	Select Care Drugs	4	11	1	2	6	3		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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	004	0	1	01	01	H9276_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	004	0	1	01	01	H9276_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								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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	004	0	1	01	01	H9276_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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	004	0	1	01	01	H9276_004_0	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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9276	004	0	1	01	01	H9276_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								47.00	94.00	141.00					0.00	0.00	0.00					0.00	0.00	0.00																47.00				47.00			1.57	0.00	0.00			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	004	0	1	01	01	H9276_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		31								100.00	200.00	300.00					45.00	90.00	135.00					45.00	90.00	135.00																100.00				100.00			3.33	1.50	1.50			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	004	0	1	01	01	H9276_004_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, Select Care Drugs												
H9276	004	0	1	01	01	H9276_004_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	004	0	1	01	01	H9276_004_0	5	Select Care Drugs	4	11	1	2	6	3		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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	006	0	1	01	01	H9276_006_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					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 Drug, Specialty Tier, Select Care Drugs												
H9276	006	0	1	01	01	H9276_006_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					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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	006	0	1	01	01	H9276_006_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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	006	0	1	01	01	H9276_006_0	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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9276	006	0	1	01	01	H9276_006_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					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, Select Care Drugs												
H9276	006	0	1	01	01	H9276_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		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 Drug, Specialty Tier, Select Care Drugs												
H9276	006	0	1	01	01	H9276_006_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, Select Care Drugs												
H9276	006	0	1	01	01	H9276_006_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	006	0	1	01	01	H9276_006_0	5	Select Care Drugs	4	11	1	2	6	3		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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	010	0	1	01	01	H9276_010_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					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 Drug, Specialty Tier, Select Care Drugs												
H9276	010	0	1	01	01	H9276_010_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					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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	010	0	1	01	01	H9276_010_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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	010	0	1	01	01	H9276_010_0	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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9276	010	0	1	01	01	H9276_010_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					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, Select Care Drugs												
H9276	010	0	1	01	01	H9276_010_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	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	010	0	1	01	01	H9276_010_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, Select Care Drugs												
H9276	010	0	1	01	01	H9276_010_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	010	0	1	01	01	H9276_010_0	5	Select Care Drugs	4	11	1	2	6	3		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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	012	0	1	01	01	H9276_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	012	0	1	01	01	H9276_012_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					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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	012	0	1	01	01	H9276_012_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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	012	0	1	01	01	H9276_012_0	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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9276	012	0	1	01	01	H9276_012_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					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, Select Care Drugs												
H9276	012	0	1	01	01	H9276_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		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 Drug, Specialty Tier, Select Care Drugs												
H9276	012	0	1	01	01	H9276_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, Select Care Drugs												
H9276	012	0	1	01	01	H9276_012_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	012	0	1	01	01	H9276_012_0	5	Select Care Drugs	4	11	1	2	6	3		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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	021	0	1	01	01	H9276_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	021	0	1	01	01	H9276_021_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					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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	021	0	1	01	01	H9276_021_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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	021	0	1	01	01	H9276_021_0	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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9276	021	0	1	01	01	H9276_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					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, Select Care Drugs												
H9276	021	0	1	01	01	H9276_021_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	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	021	0	1	01	01	H9276_021_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, Select Care Drugs												
H9276	021	0	1	01	01	H9276_021_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	021	0	1	01	01	H9276_021_0	5	Select Care Drugs	4	11	1	2	6	3		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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	022	0	1	01	01	H9276_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	022	0	1	01	01	H9276_022_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					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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	022	0	1	01	01	H9276_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	60.00					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	022	0	1	01	01	H9276_022_0	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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9276	022	0	1	01	01	H9276_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					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, Select Care Drugs												
H9276	022	0	1	01	01	H9276_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	022	0	1	01	01	H9276_022_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, Select Care Drugs												
H9276	022	0	1	01	01	H9276_022_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	022	0	1	01	01	H9276_022_0	5	Select Care Drugs	4	11	1	2	6	3		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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	023	0	1	01	01	H9276_023_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					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 Drug, Specialty Tier, Select Care Drugs												
H9276	023	0	1	01	01	H9276_023_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					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 Drug, Specialty Tier, Select Care Drugs										1		
H9276	023	0	1	01	01	H9276_023_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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	023	0	1	01	01	H9276_023_0	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					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9276	023	0	1	01	01	H9276_023_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					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, Select Care Drugs												
H9276	023	0	1	01	01	H9276_023_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	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	023	0	1	01	01	H9276_023_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, Select Care Drugs												
H9276	023	0	1	01	01	H9276_023_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								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 Drug, Specialty Tier, Select Care Drugs												
H9276	023	0	1	01	01	H9276_023_0	5	Select Care Drugs	4	11	1	2	6	3		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 Drug, Specialty Tier, Select Care Drugs										1		
H9287	001	0	1	01	01	H9287_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								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 Drug, Specialty Tier, Select Care Drugs												
H9287	001	0	1	01	01	H9287_001_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	18.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9287	001	0	1	01	01	H9287_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					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 Drug, Specialty Tier, Select Care Drugs												
H9287	001	0	1	01	01	H9287_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					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 Drug, Specialty Tier, Select Care Drugs												
H9287	001	0	1	01	01	H9287_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, Select Care Drugs												
H9287	001	0	1	01	01	H9287_001_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 Drug, Specialty Tier, Select Care Drugs												
H9302	003	0	1	01	01	H9302_003_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	62	93				2	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	5	Generic	4	01	1	2	2	1	111		01	100		1	31	62	93				2	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	5	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	62	93				2	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	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	31	62	93				2	2			93				31		31				36.65	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	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												
H9302	007	0	1	01	01	H9302_007_0	5	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	62	93				2	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	5	Generic	4	01	1	2	2	1	111		01	100		1	31	62	93				2	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	5	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	62	93				2	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	5	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	31	62	93				2	2			93				31		31				36.17	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	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												
H9302	011	0	1	01	01	H9302_011_0	6	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	62	93				2	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	6	Generic	4	01	1	2	2	1	111		01	100		1	31	62	93				2	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	6	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	62	93				2	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	6	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	31	62	93				2	2			93				31		31				43.09	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	6	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												
H9364	001	0	1	01	01	H9364_001_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	001	0	1	01	01	H9364_001_0	3	Generic	4	11	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		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	001	0	1	01	01	H9364_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		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	001	0	1	01	01	H9364_001_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.23	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	001	0	1	01	01	H9364_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 Drug, Specialty Tier												
H9364	002	0	1	01	01	H9364_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	002	0	1	01	01	H9364_002_0	5	Generic	3	11	1	2	2	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												
H9364	002	0	1	01	01	H9364_002_0	5	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		88.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	002	0	1	01	01	H9364_002_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.37	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	002	0	1	01	01	H9364_002_0	5	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												
H9403	001	0	1	01	01	H9403_001_0	8	Preferred Generic	4	01	1	1	1	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												
H9403	001	0	1	01	01	H9403_001_0	8	Generic	4	01	3	1	2	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												
H9403	001	0	1	01	01	H9403_001_0	8	Preferred Brand	4	10	1	1	3	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												
H9403	001	0	1	01	01	H9403_001_0	8	Non-Preferred Drug	4	11	1	1	4	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												
H9403	001	0	1	01	01	H9403_001_0	8	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												
H9403	003	0	1	01	01	H9403_003_0	7	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	7	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	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																					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	7	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	7	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				605.71	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	7	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	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	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	004	0	1	01	01	H9403_004_0	8	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	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 Drug, Specialty Tier												
H9403	004	0	1	01	01	H9403_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	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	004	0	1	01	01	H9403_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		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												
H9403	004	0	1	01	01	H9403_004_0	8	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				657.94	28	28	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	5	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					4.00	7.00	8.00					4.00	7.00	8.00																	15.00			15.00			0.48	0.13	0.13			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	001	0	1	04	01	H9408_001_0	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	10	010		1				31					31							10	31											1185.57	33						1185.57	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	5	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	5	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					2.00	3.50	4.00					2.00	3.50	4.00																	10.00			10.00			0.32	0.06	0.06			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	002	0	1	04	01	H9408_002_0	5	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	5	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	5	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	5	Specialty Tier	4	11	1	1	5	1		010	10	010		1				31					31							10	31											1315.82	33						1315.82	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	5	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												
H9431	001	0	1	04	01	H9431_001_0	3	Preferred Generic	4	01	1	2	1	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												
H9431	001	0	1	04	01	H9431_001_0	3	Preferred Generic	4	01	1	2	1	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		
H9431	001	0	1	04	01	H9431_001_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H9431	001	0	1	04	01	H9431_001_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H9431	001	0	1	04	01	H9431_001_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	001	0	1	04	01	H9431_001_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												
H9431	001	0	1	04	01	H9431_001_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												
H9431	002	0	1	04	01	H9431_002_0	3	Preferred Generic	4	01	1	2	1	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												
H9431	002	0	1	04	01	H9431_002_0	3	Preferred Generic	4	01	1	2	1	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		
H9431	002	0	1	04	01	H9431_002_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	002	0	1	04	01	H9431_002_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	002	0	1	04	01	H9431_002_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	002	0	1	04	01	H9431_002_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												
H9431	002	0	1	04	01	H9431_002_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												
H9431	003	0	1	04	01	H9431_003_0	3	Preferred Generic	4	01	1	2	1	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												
H9431	003	0	1	04	01	H9431_003_0	3	Preferred Generic	4	01	1	2	1	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		
H9431	003	0	1	04	01	H9431_003_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	003	0	1	04	01	H9431_003_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	003	0	1	04	01	H9431_003_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	003	0	1	04	01	H9431_003_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												
H9431	003	0	1	04	01	H9431_003_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												
H9431	004	0	1	04	01	H9431_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								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												
H9431	004	0	1	04	01	H9431_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								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		
H9431	004	0	1	04	01	H9431_004_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	004	0	1	04	01	H9431_004_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	004	0	1	04	01	H9431_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	004	0	1	04	01	H9431_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												
H9431	004	0	1	04	01	H9431_004_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												
H9431	005	0	1	04	01	H9431_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								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												
H9431	005	0	1	04	01	H9431_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								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		
H9431	005	0	1	04	01	H9431_005_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	005	0	1	04	01	H9431_005_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	005	0	1	04	01	H9431_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	005	0	1	04	01	H9431_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												
H9431	005	0	1	04	01	H9431_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												
H9431	006	0	1	04	01	H9431_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								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												
H9431	006	0	1	04	01	H9431_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								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		
H9431	006	0	1	04	01	H9431_006_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	006	0	1	04	01	H9431_006_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	006	0	1	04	01	H9431_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	006	0	1	04	01	H9431_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												
H9431	006	0	1	04	01	H9431_006_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												
H9431	007	0	1	04	01	H9431_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								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												
H9431	007	0	1	04	01	H9431_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								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		
H9431	007	0	1	04	01	H9431_007_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	007	0	1	04	01	H9431_007_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	007	0	1	04	01	H9431_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	007	0	1	04	01	H9431_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												
H9431	007	0	1	04	01	H9431_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												
H9431	008	0	1	04	01	H9431_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								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												
H9431	008	0	1	04	01	H9431_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								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		
H9431	008	0	1	04	01	H9431_008_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	008	0	1	04	01	H9431_008_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					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	008	0	1	04	01	H9431_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	008	0	1	04	01	H9431_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												
H9431	008	0	1	04	01	H9431_008_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												
H9431	009	0	1	04	01	H9431_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								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												
H9431	009	0	1	04	01	H9431_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								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		
H9431	009	0	1	04	01	H9431_009_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H9431	009	0	1	04	01	H9431_009_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H9431	009	0	1	04	01	H9431_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	009	0	1	04	01	H9431_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												
H9431	009	0	1	04	01	H9431_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												
H9431	010	0	1	04	01	H9431_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								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												
H9431	010	0	1	04	01	H9431_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								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		
H9431	010	0	1	04	01	H9431_010_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					0.00	0.00	0.00											20.00	40.00	60.00				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												
H9431	010	0	1	04	01	H9431_010_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					0.00	0.00	0.00											20.00	40.00	60.00				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		
H9431	010	0	1	04	01	H9431_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	010	0	1	04	01	H9431_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												
H9431	010	0	1	04	01	H9431_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												
H9431	011	0	1	04	01	H9431_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	011	0	1	04	01	H9431_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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	011	0	1	04	01	H9431_011_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	011	0	1	04	01	H9431_011_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	10.00					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		
H9431	011	0	1	04	01	H9431_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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	011	0	1	04	01	H9431_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												
H9431	011	0	1	04	01	H9431_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												
H9431	012	0	1	04	01	H9431_012_0	3	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	012	0	1	04	01	H9431_012_0	3	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	012	0	1	04	01	H9431_012_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	012	0	1	04	01	H9431_012_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	10.00					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		
H9431	012	0	1	04	01	H9431_012_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	012	0	1	04	01	H9431_012_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												
H9431	012	0	1	04	01	H9431_012_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												
H9460	001	0	1	01	01	H9460_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								7.00	14.00	14.00					2.00	4.00	0.00											7.00	14.00	14.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	20.00					5.00	10.00	10.00											10.00	20.00	20.00				5.00	10.00	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												
H9460	001	0	1	01	01	H9460_001_0	4	Preferred Brand	4	11	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											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												
H9460	001	0	1	01	01	H9460_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											89.10	50	50	50				84.83	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											627.70	30						541.28	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9487	001	0	1	48	05	H9487_001_0	6	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	6	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	6	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			
H9516	001	0	1	04	01	H9516_001_0	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9516	001	0	1	04	01	H9516_001_0	11	Generic	4	11	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				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9516	001	0	1	04	01	H9516_001_0	11	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 Drug, Specialty Tier												
H9516	001	0	1	04	01	H9516_001_0	11	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9516	001	0	1	04	01	H9516_001_0	11	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				624.00	29		29																		29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9516	002	0	1	04	01	H9516_002_0	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9516	002	0	1	04	01	H9516_002_0	11	Generic	4	11	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												
H9516	002	0	1	04	01	H9516_002_0	11	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 Drug, Specialty Tier												
H9516	002	0	1	04	01	H9516_002_0	11	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9516	002	0	1	04	01	H9516_002_0	11	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				690.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9525	003	0	1	01	01	H9525_003_0	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								5.00	10.00	15.00					5.00	10.00	15.00					5.00		15.00																5.00				5.00			0.17	0.17	0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00		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	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H9525	003	0	1	01	01	H9525_003_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	10	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00		4.00																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												
H9525	004	0	1	01	01	H9525_004_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00		18.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	11	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	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00		4.00																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												
H9525	006	0	1	01	01	H9525_006_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00		18.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	11	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	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	10	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	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	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	10	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								3.00	6.00	9.00					3.00	6.00	9.00					3.00		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												
H9525	007	0	1	01	01	H9525_007_0	10	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00		135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	007	0	1	01	01	H9525_007_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		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	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												
H9525	007	0	1	01	01	H9525_007_0	10	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	10	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	11	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00		4.00																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												
H9525	008	0	1	01	01	H9525_008_0	11	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00		18.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	008	0	1	01	01	H9525_008_0	11	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	11	Non-Preferred Drug	4	11	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00		190.00																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	11	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	11	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	11	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	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, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_1	4	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, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_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, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_1	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											42.00	48		48				42.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_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, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_1	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	2	1	04	01	H9572_001_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, Select Care Drugs												
H9572	001	2	1	04	01	H9572_001_2	4	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, Select Care Drugs												
H9572	001	2	1	04	01	H9572_001_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, Select Care Drugs												
H9572	001	2	1	04	01	H9572_001_2	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											42.00	48		48				42.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	2	1	04	01	H9572_001_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, Select Care Drugs												
H9572	001	2	1	04	01	H9572_001_2	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	3	1	04	01	H9572_001_3	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, Select Care Drugs												
H9572	001	3	1	04	01	H9572_001_3	4	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, Select Care Drugs												
H9572	001	3	1	04	01	H9572_001_3	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, Select Care Drugs												
H9572	001	3	1	04	01	H9572_001_3	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											42.00	48		48				42.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	3	1	04	01	H9572_001_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, Select Care Drugs												
H9572	001	3	1	04	01	H9572_001_3	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	4	1	04	01	H9572_001_4	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, Select Care Drugs												
H9572	001	4	1	04	01	H9572_001_4	4	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, Select Care Drugs												
H9572	001	4	1	04	01	H9572_001_4	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, Select Care Drugs												
H9572	001	4	1	04	01	H9572_001_4	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											42.00	48		48				42.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	4	1	04	01	H9572_001_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, Select Care Drugs												
H9572	001	4	1	04	01	H9572_001_4	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	6	1	04	01	H9572_001_6	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, Select Care Drugs												
H9572	001	6	1	04	01	H9572_001_6	4	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, Select Care Drugs												
H9572	001	6	1	04	01	H9572_001_6	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, Select Care Drugs												
H9572	001	6	1	04	01	H9572_001_6	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											42.00	48		48				42.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	6	1	04	01	H9572_001_6	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, Select Care Drugs												
H9572	001	6	1	04	01	H9572_001_6	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	1	1	04	01	H9572_002_1	4	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, Select Care Drugs												
H9572	002	1	1	04	01	H9572_002_1	4	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, Select Care Drugs												
H9572	002	1	1	04	01	H9572_002_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, Select Care Drugs												
H9572	002	1	1	04	01	H9572_002_1	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	50		50				62.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	1	1	04	01	H9572_002_1	4	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, Select Care Drugs												
H9572	002	1	1	04	01	H9572_002_1	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	2	1	04	01	H9572_002_2	4	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, Select Care Drugs												
H9572	002	2	1	04	01	H9572_002_2	4	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, Select Care Drugs												
H9572	002	2	1	04	01	H9572_002_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, Select Care Drugs												
H9572	002	2	1	04	01	H9572_002_2	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	50		50				62.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	2	1	04	01	H9572_002_2	4	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, Select Care Drugs												
H9572	002	2	1	04	01	H9572_002_2	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	3	1	04	01	H9572_002_3	4	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, Select Care Drugs												
H9572	002	3	1	04	01	H9572_002_3	4	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, Select Care Drugs												
H9572	002	3	1	04	01	H9572_002_3	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, Select Care Drugs												
H9572	002	3	1	04	01	H9572_002_3	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	50		50				62.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	3	1	04	01	H9572_002_3	4	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, Select Care Drugs												
H9572	002	3	1	04	01	H9572_002_3	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	4	1	04	01	H9572_002_4	4	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, Select Care Drugs												
H9572	002	4	1	04	01	H9572_002_4	4	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, Select Care Drugs												
H9572	002	4	1	04	01	H9572_002_4	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, Select Care Drugs												
H9572	002	4	1	04	01	H9572_002_4	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	50		50				62.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	4	1	04	01	H9572_002_4	4	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, Select Care Drugs												
H9572	002	4	1	04	01	H9572_002_4	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	6	1	04	01	H9572_002_6	4	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, Select Care Drugs												
H9572	002	6	1	04	01	H9572_002_6	4	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, Select Care Drugs												
H9572	002	6	1	04	01	H9572_002_6	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, Select Care Drugs												
H9572	002	6	1	04	01	H9572_002_6	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											62.00	50		50				62.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	6	1	04	01	H9572_002_6	4	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, Select Care Drugs												
H9572	002	6	1	04	01	H9572_002_6	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	1	1	04	01	H9572_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, Select Care Drugs												
H9572	003	1	1	04	01	H9572_003_1	4	Generic	4	01	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, Select Care Drugs												
H9572	003	1	1	04	01	H9572_003_1	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								42.00		126.00					37.00		111.00											42.00		126.00				37.00		111.00				42.00				42.00			1.35	1.19		1.35	1.19	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	1	1	04	01	H9572_003_1	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											44.00	45		45				44.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	1	1	04	01	H9572_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, Select Care Drugs												
H9572	003	1	1	04	01	H9572_003_1	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	2	1	04	01	H9572_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, Select Care Drugs												
H9572	003	2	1	04	01	H9572_003_2	4	Generic	4	01	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, Select Care Drugs												
H9572	003	2	1	04	01	H9572_003_2	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								42.00		126.00					37.00		111.00											42.00		126.00				37.00		111.00				42.00				42.00			1.35	1.19		1.35	1.19	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	2	1	04	01	H9572_003_2	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											44.00	45		45				44.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	2	1	04	01	H9572_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, Select Care Drugs												
H9572	003	2	1	04	01	H9572_003_2	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	3	1	04	01	H9572_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, Select Care Drugs												
H9572	003	3	1	04	01	H9572_003_3	4	Generic	4	01	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, Select Care Drugs												
H9572	003	3	1	04	01	H9572_003_3	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								42.00		126.00					37.00		111.00											42.00		126.00				37.00		111.00				42.00				42.00			1.35	1.19		1.35	1.19	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	3	1	04	01	H9572_003_3	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											44.00	45		45				44.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	3	1	04	01	H9572_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, Select Care Drugs												
H9572	003	3	1	04	01	H9572_003_3	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	4	1	04	01	H9572_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, Select Care Drugs												
H9572	003	4	1	04	01	H9572_003_4	4	Generic	4	01	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, Select Care Drugs												
H9572	003	4	1	04	01	H9572_003_4	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								42.00		126.00					37.00		111.00											42.00		126.00				37.00		111.00				42.00				42.00			1.35	1.19		1.35	1.19	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	4	1	04	01	H9572_003_4	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											44.00	45		45				44.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	4	1	04	01	H9572_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, Select Care Drugs												
H9572	003	4	1	04	01	H9572_003_4	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	6	1	04	01	H9572_003_6	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, Select Care Drugs												
H9572	003	6	1	04	01	H9572_003_6	4	Generic	4	01	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, Select Care Drugs												
H9572	003	6	1	04	01	H9572_003_6	4	Preferred Brand	4	10	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								42.00		126.00					37.00		111.00											42.00		126.00				37.00		111.00				42.00				42.00			1.35	1.19		1.35	1.19	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	6	1	04	01	H9572_003_6	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											44.00	45		45				44.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	6	1	04	01	H9572_003_6	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, Select Care Drugs												
H9572	003	6	1	04	01	H9572_003_6	4	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	1	1	04	01	H9572_004_1	4	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, Select Care Drugs												
H9572	004	1	1	04	01	H9572_004_1	4	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, Select Care Drugs												
H9572	004	1	1	04	01	H9572_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, Select Care Drugs												
H9572	004	1	1	04	01	H9572_004_1	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											69.00	50		50				69.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	1	1	04	01	H9572_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, Select Care Drugs												
H9572	004	1	1	04	01	H9572_004_1	4	Select Care Drugs	3	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	2	1	04	01	H9572_004_2	4	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, Select Care Drugs												
H9572	004	2	1	04	01	H9572_004_2	4	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, Select Care Drugs												
H9572	004	2	1	04	01	H9572_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, Select Care Drugs												
H9572	004	2	1	04	01	H9572_004_2	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											69.00	50		50				69.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	2	1	04	01	H9572_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, Select Care Drugs												
H9572	004	2	1	04	01	H9572_004_2	4	Select Care Drugs	3	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	3	1	04	01	H9572_004_3	4	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, Select Care Drugs												
H9572	004	3	1	04	01	H9572_004_3	4	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, Select Care Drugs												
H9572	004	3	1	04	01	H9572_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, Select Care Drugs												
H9572	004	3	1	04	01	H9572_004_3	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											69.00	50		50				69.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	3	1	04	01	H9572_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, Select Care Drugs												
H9572	004	3	1	04	01	H9572_004_3	4	Select Care Drugs	3	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	4	1	04	01	H9572_004_4	4	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, Select Care Drugs												
H9572	004	4	1	04	01	H9572_004_4	4	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, Select Care Drugs												
H9572	004	4	1	04	01	H9572_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, Select Care Drugs												
H9572	004	4	1	04	01	H9572_004_4	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											69.00	50		50				69.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	4	1	04	01	H9572_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, Select Care Drugs												
H9572	004	4	1	04	01	H9572_004_4	4	Select Care Drugs	3	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	6	1	04	01	H9572_004_6	4	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, Select Care Drugs												
H9572	004	6	1	04	01	H9572_004_6	4	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, Select Care Drugs												
H9572	004	6	1	04	01	H9572_004_6	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, Select Care Drugs												
H9572	004	6	1	04	01	H9572_004_6	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											69.00	50		50				69.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	6	1	04	01	H9572_004_6	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, Select Care Drugs												
H9572	004	6	1	04	01	H9572_004_6	4	Select Care Drugs	3	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9576	001	0	1	48	05	H9576_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	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	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	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	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				2	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			
H9589	001	0	1	04	01	H9589_001_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	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	6	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	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																					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	6	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	6	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				607.72	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	6	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	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												
H9589	003	0	1	04	01	H9589_003_0	7	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	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 Drug, Specialty Tier												
H9589	003	0	1	04	01	H9589_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	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												
H9589	003	0	1	04	01	H9589_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		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												
H9589	003	0	1	04	01	H9589_003_0	7	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				640.46	28	28	28																		28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_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												
H9615	007	0	1	04	01	H9615_007_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9615	007	0	1	04	01	H9615_007_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		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_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		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				85.80	27		27																		27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				770.67	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	008	0	1	04	01	H9615_008_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												
H9615	008	0	1	04	01	H9615_008_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																			11.00		22.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	008	0	1	04	01	H9615_008_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		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	008	0	1	04	01	H9615_008_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				88.27	27		27																		27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	008	0	1	04	01	H9615_008_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				696.12	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	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	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		20.00																10.00				10.00		0.33			0.33			0.32	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		70.00																35.00				35.00		1.17			1.17			1.13	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				87.81	27		27																		27		27															27			27								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				800.19	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	0.00		0.00																			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	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																			11.00		22.00																11.00				11.00		0.37			0.37			0.35	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		94.00																47.00				47.00		1.57			1.57			1.52	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				97.24	27		27																		27		27															27			27								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				803.29	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	012	0	1	04	01	H9615_012_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												
H9615	012	0	1	04	01	H9615_012_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		24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	012	0	1	04	01	H9615_012_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		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	012	0	1	04	01	H9615_012_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				89.96	27		27																		27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	012	0	1	04	01	H9615_012_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				810.03	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9630	001	0	1	01	01	H9630_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												
H9630	001	0	1	01	01	H9630_001_0	4	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																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	001	0	1	01	01	H9630_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												
H9630	001	0	1	01	01	H9630_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												
H9630	001	0	1	01	01	H9630_001_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, Select Care Drugs												
H9630	001	0	1	01	01	H9630_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												
H9630	002	0	1	01	01	H9630_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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	6	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																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_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 Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_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, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	6	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, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_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	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	6	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																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_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 Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_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, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	6	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, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	004	0	1	01	01	H9630_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												
H9630	004	0	1	01	01	H9630_004_0	4	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																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	004	0	1	01	01	H9630_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												
H9630	004	0	1	01	01	H9630_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												
H9630	004	0	1	01	01	H9630_004_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, Select Care Drugs												
H9630	004	0	1	01	01	H9630_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												
H9630	005	0	1	01	01	H9630_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, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	4	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																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_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 Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_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																			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												
H9630	005	0	1	01	01	H9630_005_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, Select Care Drugs												
H9630	005	0	1	01	01	H9630_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 Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	8	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 Drug, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	8	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 Drug, Specialty Tier										1		
H9699	004	1	1	01	01	H9699_004_1	8	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 Drug, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	8	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 Drug, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											35.00	50		50				30.00	45		45				45		45															50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	8	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 Drug, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	8	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 Drug, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	8	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 Drug, Specialty Tier										1		
H9699	004	2	1	01	01	H9699_004_2	8	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 Drug, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	8	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 Drug, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											35.00	50		50				30.00	45		45				45		45															50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	8	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 Drug, Specialty Tier												
H9699	004	3	1	01	01	H9699_004_3	8	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 Drug, Specialty Tier												
H9699	004	3	1	01	01	H9699_004_3	8	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 Drug, Specialty Tier										1		
H9699	004	3	1	01	01	H9699_004_3	8	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 Drug, Specialty Tier												
H9699	004	3	1	01	01	H9699_004_3	8	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 Drug, Specialty Tier												
H9699	004	3	1	01	01	H9699_004_3	8	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											35.00	50		50				30.00	45		45				45		45															50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9699	004	3	1	01	01	H9699_004_3	8	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 Drug, Specialty Tier												
H9712	001	0	1	48	05	H9712_001_0	10	Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9712	001	0	1	48	05	H9712_001_0	10	Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	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	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	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	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	20.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	2	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												
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	2	2				30	60	90	30		31											75.67	50	50	50				69.18	50	50	50										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											524.94	27						530.17	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	006	0	1	01	01	H9725_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								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												
H9725	006	0	1	01	01	H9725_006_0	4	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	20.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	006	0	1	01	01	H9725_006_0	4	Preferred Brand	4	11	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											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												
H9725	006	0	1	01	01	H9725_006_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.20	47	47	47				90.08	47	47	47										47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	006	0	1	01	01	H9725_006_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											700.83	33						708.37	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	002	0	1	01	01	H9730_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	002	0	1	01	01	H9730_002_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H9730	002	0	1	01	01	H9730_002_0	3	Generic	4	11	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		0.00				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		94.00				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				72.09	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					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	3	Generic	3	11	1	2	2	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												
H9730	003	0	1	01	01	H9730_003_0	3	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		84.00				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	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.36	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	3	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												
H9730	004	0	1	01	01	H9730_004_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	004	0	1	01	01	H9730_004_0	3	Generic	3	11	1	2	2	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												
H9730	004	0	1	01	01	H9730_004_0	3	Preferred Brand	3	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	39.00		117.00																									39.00		117.00				39.00		78.00				39.00				39.00		1.30				1.30	1.30	1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	004	0	1	01	01	H9730_004_0	3	Non-Preferred Drug	3	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				89.61	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	3	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												
H9730	005	0	1	02	01	H9730_005_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	005	0	1	02	01	H9730_005_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	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H9730	005	0	1	02	01	H9730_005_0	3	Generic	4	11	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		0.00				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		94.00				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				71.63	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					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	7	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	7	Preferred Generic	4	01	1	2	1	3	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		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9808	004	0	1	04	01	H9808_004_0	7	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	7	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	7	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												
H9808	004	0	1	04	01	H9808_004_0	7	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	7	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	7	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	7	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	7	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	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	80.00	160.00	160.00																			80.00	160.00	160.00																	80.00			80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	7	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												
H9808	006	0	1	04	01	H9808_006_0	7	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	006	0	1	04	01	H9808_006_0	7	Preferred Generic	4	01	1	2	1	3	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		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9808	006	0	1	04	01	H9808_006_0	7	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	006	0	1	04	01	H9808_006_0	7	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	006	0	1	04	01	H9808_006_0	7	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												
H9808	006	0	1	04	01	H9808_006_0	7	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	007	0	1	04	01	H9808_007_0	7	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	007	0	1	04	01	H9808_007_0	7	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	007	0	1	04	01	H9808_007_0	7	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	007	0	1	04	01	H9808_007_0	7	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	007	0	1	04	01	H9808_007_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	80.00	160.00	160.00																			80.00	160.00	160.00																	80.00			80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	007	0	1	04	01	H9808_007_0	7	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	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, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	7	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 Drug, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_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	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 Drug, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_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, Select Care Drugs												
H9811	001	0	1	01	01	H9811_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, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	7	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												
H9811	005	0	1	01	01	H9811_005_0	6	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												
H9811	005	0	1	01	01	H9811_005_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 Drug, Specialty Tier, Select Care Drugs												
H9811	005	0	1	01	01	H9811_005_0	6	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 Drug, Specialty Tier, Select Care Drugs												
H9811	005	0	1	01	01	H9811_005_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, Select Care Drugs												
H9811	005	0	1	01	01	H9811_005_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 Drug, Specialty Tier, Select Care Drugs												
H9811	005	0	1	01	01	H9811_005_0	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	006	0	1	01	01	H9811_006_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												
H9811	006	0	1	01	01	H9811_006_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		.67			.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	006	0	1	01	01	H9811_006_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												
H9811	006	0	1	01	01	H9811_006_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												
H9811	006	0	1	01	01	H9811_006_0	6	Specialty Tier	3	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, Select Care Drugs												
H9811	006	0	1	01	01	H9811_006_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												
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				45.20	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			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_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	003	0	1	01	01	H9834_003_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	003	0	1	01	01	H9834_003_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	003	0	1	01	01	H9834_003_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				47.62	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	3	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												
H9869	001	0	1	48	05	H9869_001_0	7	Generic Drugs	4	01			1	1	110		01	101		1	30		90				1	1		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			
H9869	001	0	1	48	05	H9869_001_0	7	Brand Drugs	4	10			2	1	110		01	101		1	30		90				1	1		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			
H9869	001	0	1	48	05	H9869_001_0	7	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01	101		1	30		90				1	1		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			
H9877	002	0	1	01	01	H9877_002_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	002	0	1	01	01	H9877_002_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	002	0	1	01	01	H9877_002_0	6	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	6	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	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	002	0	1	01	01	H9877_002_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	002	0	1	01	01	H9877_002_0	6	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												
H9878	001	0	1	04	01	H9878_001_0	11	Preferred Generic	4	11	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			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9878	001	0	1	04	01	H9878_001_0	11	Generic	4	11	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												
H9878	001	0	1	04	01	H9878_001_0	11	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				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9878	001	0	1	04	01	H9878_001_0	11	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9878	001	0	1	04	01	H9878_001_0	11	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				652.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9878	002	0	1	04	01	H9878_002_0	11	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9878	002	0	1	04	01	H9878_002_0	11	Generic	4	11	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												
H9878	002	0	1	04	01	H9878_002_0	11	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				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9878	002	0	1	04	01	H9878_002_0	11	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		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9878	002	0	1	04	01	H9878_002_0	11	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				645.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	002	0	1	31	11	R0110_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					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												
R0110	002	0	1	31	11	R0110_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	002	0	1	31	11	R0110_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	002	0	1	31	11	R0110_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	002	0	1	31	11	R0110_002_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												
R0110	003	0	1	31	11	R0110_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_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												
R0802	001	0	1	31	11	R0802_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								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	5.00																4.00				4.00			0.13	0.07	0.07			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0802	001	0	1	31	11	R0802_001_0	7	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					10.00	20.00	25.00																18.00				18.00			0.60	0.33	0.33			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0802	001	0	1	31	11	R0802_001_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					40.00	80.00	120.00					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												
R0802	001	0	1	31	11	R0802_001_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					95.00	190.00	285.00					95.00	190.00	237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0802	001	0	1	31	11	R0802_001_0	7	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	27	27	27				600.00	27	27	27				27	27	27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_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												
R0923	002	0	1	31	11	R0923_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												
R0923	002	0	1	31	11	R0923_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_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												
R1390	002	0	1	31	11	R1390_002_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												
R1390	002	0	1	31	11	R1390_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_0	6	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												
R1532	002	0	1	31	11	R1532_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					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												
R1532	002	0	1	31	11	R1532_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_002_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												
R3332	001	0	1	31	11	R3332_001_0	8	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 Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	8	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 Drug, Specialty Tier, Select Care Drugs										1		
R3332	001	0	1	31	11	R3332_001_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					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 Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_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		141.00																47.00				47.00			1.52	1.52	1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	8	Non-Preferred Drug	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 Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	8	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 Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	8	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 Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	8	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 Drug, Specialty Tier, Select Care Drugs										1		
R3392	002	0	1	31	11	R3392_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	002	0	1	31	11	R3392_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	002	0	1	31	11	R3392_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	002	0	1	31	11	R3392_002_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												
R3444	009	0	1	31	11	R3444_009_0	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		7.50																											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				2	2						90	30		31	12.00		30.00																											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				2	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				2	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				2	2						90	30		31				988.00	29		29																										29						29			29			29								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				2	2						90	30		31	4.00		10.00																											12.00						0.00				4.00				4.00		0.13						0.12	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				2	2						90	30		31	15.00		37.50																											45.00						0.00				15.00				15.00		0.50						0.48	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				2	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				2	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				2	2						90	30		31				804.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3887	002	0	1	31	11	R3887_002_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					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												
R3887	002	0	1	31	11	R3887_002_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3887	002	0	1	31	11	R3887_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3887	002	0	1	31	11	R3887_002_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3887	002	0	1	31	11	R3887_002_0	6	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												
R4182	003	0	1	31	11	R4182_003_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												
R4182	003	0	1	31	11	R4182_003_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_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					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_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												
R4182	004	0	1	31	11	R4182_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					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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	004	0	1	31	11	R4182_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	004	0	1	31	11	R4182_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	004	0	1	31	11	R4182_004_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												
R4487	001	0	1	31	11	R4487_001_0	9	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								11.00	22.00	33.00					6.00	12.00	18.00					6.00		12.00																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												
R4487	001	0	1	31	11	R4487_001_0	9	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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												
R4487	001	0	1	31	11	R4487_001_0	9	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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												
R4487	001	0	1	31	11	R4487_001_0	9	Non-Preferred Drug	4	11	1	1	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34											97.10	47	47	47				95.03	46	46	46				46		46															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R4487	001	0	1	31	11	R4487_001_0	9	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												
R4487	001	0	1	31	11	R4487_001_0	9	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R4487	001	0	1	31	11	R4487_001_0	9	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
R4845	002	0	1	31	11	R4845_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4845	002	0	1	31	11	R4845_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4845	002	0	1	31	11	R4845_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4845	002	0	1	31	11	R4845_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												
R5329	001	0	1	31	11	R5329_001_0	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	2	2	1	110		01		100	1	30		90				2	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	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	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
R5329	001	0	1	31	11	R5329_001_0	4	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	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				2	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				2	2						90	30		31				1111.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				904.00	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	4	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	4	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	4	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						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	4	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	4	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				883.00	27		27																										27						27			27			27								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				2	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				2	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				2	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				2	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				2	2						90	30		31				1010.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_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					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												
R5361	002	0	1	31	11	R5361_002_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_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												
R5495	002	0	1	31	11	R5495_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												
R5495	002	0	1	31	11	R5495_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_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					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_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												
R5826	005	0	1	31	11	R5826_005_0	5	Preferred Generic	4	11	3	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												
R5826	005	0	1	31	11	R5826_005_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	5	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	6	Preferred Generic	4	11	3	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												
R5826	074	0	1	31	11	R5826_074_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_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												
R5941	014	0	1	31	11	R5941_014_0	8	Preferred Generic	4	01	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		34								11.00	22.00	33.00					6.00	12.00	18.00					6.00		0.00																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	8	Generic	4	01	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00		30.00																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	8	Preferred Brand	4	11	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00		84.00																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	8	Non-Preferred Drug	4	11	1	1	4	1		111	01	110		1				30	60	90	1	2	30		90				30		34											91.85	42	42	42				89.66	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	8	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	8	Select Care Drugs	4	01	1	2	6	1		111	01	110		1				30	60	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	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	8	Select Care Drugs	4	01	1	2	6	3		111	01	110		1				30	60	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	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	6	Preferred Generic	4	01	1	2	1	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												
R6694	003	0	1	31	11	R6694_003_0	6	Preferred Generic	4	01	1	2	1	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		
R6694	003	0	1	31	11	R6694_003_0	6	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					0.00	0.00	0.00											20.00	40.00	60.00				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												
R6694	003	0	1	31	11	R6694_003_0	6	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					0.00	0.00	0.00											20.00	40.00	60.00				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		
R6694	003	0	1	31	11	R6694_003_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	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_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												
R6694	003	0	1	31	11	R6694_003_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												
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								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	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								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 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					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	26						1.00	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	006	0	1	31	11	R6694_006_0	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	006	0	1	31	11	R6694_006_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	0.00											15.00	30.00	45.00				2.00	4.00	0.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R6694	006	0	1	31	11	R6694_006_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	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	006	0	1	31	11	R6694_006_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	10.00					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		
R6694	006	0	1	31	11	R6694_006_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	136.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	006	0	1	31	11	R6694_006_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	006	0	1	31	11	R6694_006_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												
R6801	008	0	1	31	11	R6801_008_0	2	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	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	2	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	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	2	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				2	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	2	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	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	2	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				828.00	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	3	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	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	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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	3	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						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	3	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	3	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				729.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_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												
R7220	002	0	1	31	11	R7220_002_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_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												
R7315	002	0	1	31	11	R7315_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					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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_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					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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_002_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												
R7444	001	0	1	31	11	R7444_001_0	5	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											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	5	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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	5	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R7444	001	0	1	31	11	R7444_001_0	5	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						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	5	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	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	5	Specialty Tier	4	11	1	1	5	1	110		01		100	1	30		90				2	2						90	30		31				796.00	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				2	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	003	0	1	31	11	R7444_003_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	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				2	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				2	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				2	2						90	30		31				838.00	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				2	2						90	30		31	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												
R7444	008	0	1	31	11	R7444_008_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		28.00																											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				2	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				2	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				2	2						90	30		31				935.00	29		29																										29						29			29			29								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				2	2						90	30		31	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												
R7444	010	0	1	31	11	R7444_010_0	3	Generic	4	01	1	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											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				2	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				2	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				2	2						90	30		31				992.00	29		29																										29						29			29			29								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								9.00		27.00					2.00		4.00					2.00		4.00																9.00				9.00			0.30	0.06	0.06			0.29	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								15.00		45.00					8.00		16.00					8.00		16.00																15.00				15.00			0.50	0.26	0.26			0.48	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					40.00		80.00					40.00		80.00																47.00				47.00			1.56	1.33	1.33			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											54.00	50		50				48.00	45		45				45		45															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	5	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		2.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	5	Generic	2	01	1	2	2	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												
S1030	006	0		29	10	S1030_006_0	5	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		94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	5	Non-Preferred Drug	2	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				66.00	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	5	Specialty Tier	2	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				66.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	010	0		29	10	S1030_010_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					1.00		2.00					1.00		2.00																8.00				8.00			0.26	0.03	0.03			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	010	0		29	10	S1030_010_0	3	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								11.00		33.00					4.00		8.00					4.00		8.00																11.00				11.00			0.36	0.13	0.13			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	010	0		29	10	S1030_010_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					40.00		80.00					40.00		80.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	010	0		29	10	S1030_010_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											62.00	50		50				54.00	45		45				45		45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	010	0		29	10	S1030_010_0	3	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 Drug, Specialty Tier												
S1894	001	0		29	10	S1894_001_0	5	Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					0.00	0.00	0.00											8.00	16.00	16.00				0.00	0.00	0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1894	001	0		29	10	S1894_001_0	5	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	32.00				6.00	12.00	12.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1894	001	0		29	10	S1894_001_0	5	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											30.44	25	25	25				11.96	10	10	10										25	25	25				10	10	10			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1894	001	0		29	10	S1894_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											85.73	40	40	40				52.81	25	25	25										40	40	40				25	25	25			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1894	001	0		29	10	S1894_001_0	5	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	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	1	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	1	Generic	3	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								15.00	30.00	45.00					6.00	12.00	12.00							12.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	1	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	01	100		1				30	60	90	2	2			90				30		31											54.67	33	33	33				51.36	31	31	31						31															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	1	Injectable Drugs	3	11	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											114.50	25	25	25				114.50	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	1	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	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	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											85.32	29	29	29				79.44	27	27	27						27															29			29								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											124.05	25	25	25				124.05	25	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	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	18	Preferred Generic	2	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			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	18	Generic	2	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	27.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	18	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																			40.00	80.00	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	18	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				59.05	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	18	Specialty Tier	2	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				240.06	25	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	18	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	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												
S2668	006	0		29	10	S2668_006_0	18	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											13.00	26.00	39.00				8.00	16.00	24.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	18	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				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	18	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											69.64	50	50	50				58.31	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	18	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											531.22	33	33	33				318.36	33	33	33										33	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	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																									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												
S2874	001	0		29	10	S2874_001_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_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 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	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	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	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												
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				23.00	25		25																								25		25				25		15			25			25								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				57.00	41		41																								41		41				41		30			41			41								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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	1	Preferred Generic	3	11	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	1	Generic	3	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					8.00	16.00	24.00					8.00	16.00	16.00																19.00				19.00			0.63	0.27	0.27			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_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								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	1	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											91.47	50	50	50				72.45	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	1	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 Drug, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	1	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					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	1	Preferred Generic	4	11	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	1	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	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	1	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	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	1	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	1	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	1	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												
S4607	002	0		29	10	S4607_002_0	1	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	20.00					1.00	2.00	2.50					1.00	2.00	2.50																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	1	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	25.00					2.00	4.00	5.00					2.00	4.00	5.00																10.00				10.00			0.33	0.07	0.07			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	1	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											24.93	19	19	19				24.78	19	19	19				19	19	19															19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	1	Non-Preferred Drug	2	10	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											56.94	43	43	43				55.84	43	43	43				43	43	43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	1	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	1	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	20.00					1.00	2.00	2.50					1.00	2.00	2.50																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	1	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	25.00					2.00	4.00	5.00					2.00	4.00	5.00																10.00				10.00			0.33	0.07	0.07			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	1	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											20.22	19	19	19				20.15	19	19	19				19	19	19															19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	1	Non-Preferred Drug	2	10	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											55.51	43	43	43				54.54	43	43	43				43	43	43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	1	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	1	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	20.00					1.00	2.00	2.50					1.00	2.00	2.50																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	1	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	25.00					2.00	4.00	5.00					2.00	4.00	5.00																10.00				10.00			0.33	0.07	0.07			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	1	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											20.54	19	19	19				20.44	19	19	19				19	19	19															19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	1	Non-Preferred Drug	2	10	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											55.54	45	45	45				54.69	45	45	45				45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	1	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	1	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	20.00					1.00	2.00	2.50					1.00	2.00	2.50																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	1	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	25.00					2.00	4.00	5.00					2.00	4.00	5.00																10.00				10.00			0.33	0.07	0.07			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	1	Preferred Brand	2	10	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											21.15	20	20	20				21.12	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	1	Non-Preferred Drug	2	10	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											55.85	45	45	45				54.95	45	45	45				45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	1	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	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	3	Generic	3	11	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	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					32.00		96.00											45.00		135.00				32.00		80.00				45.00				45.00			1.50	1.07		1.50	1.07	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.19	46		46				87.51	41		41										46		46				41		41			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_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												
S4802	013	0		29	10	S4802_013_0	3	Preferred Generic	2	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	3	Generic	2	11	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	013	0		29	10	S4802_013_0	3	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					29.00		87.00											45.00		135.00				29.00		72.50				45.00				45.00			1.50	0.97		1.50	0.97	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.28	47		47				83.64	40		40										47		47				40		40			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_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												
S4802	014	0		29	10	S4802_014_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		5.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_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					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	014	0		29	10	S4802_014_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.29	46		46				87.61	41		41										46		46				41		41			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_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												
S4802	020	0		29	10	S4802_020_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								16.00		48.00					5.00		15.00											16.00		48.00				5.00		12.50				16.00				16.00			0.53	0.17		0.53	0.17	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_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					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	020	0		29	10	S4802_020_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.74	50		50				79.79	40		40										50		50				40		40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_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												
S4802	021	0		29	10	S4802_021_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		20.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_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	021	0		29	10	S4802_021_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.18	45		45				90.37	41		41										45		45				41		41			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_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												
S4802	069	0		29	10	S4802_069_0	4	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		35.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_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					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	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.76	48		48				85.21	41		41										48		48				41		41			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_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												
S4802	070	0		29	10	S4802_070_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		17.50				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_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	070	0		29	10	S4802_070_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											95.87	50		50				76.70	40		40										50		50				40		40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_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												
S4802	071	0		29	10	S4802_071_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	3	Generic	3	11	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	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	071	0		29	10	S4802_071_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.56	45		45				92.92	42		42										45		45				42		42			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_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												
S4802	072	0		29	10	S4802_072_0	3	Preferred Generic	2	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	3	Generic	2	11	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	072	0		29	10	S4802_072_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					32.00		96.00											44.00		132.00				32.00		80.00				44.00				44.00			1.47	1.07		1.47	1.07	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.84	45		45				84.31	38		38										45		45				38		38			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_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												
S4802	073	0		29	10	S4802_073_0	3	Preferred Generic	2	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	3	Generic	2	11	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	073	0		29	10	S4802_073_0	3	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								40.00		120.00					28.00		84.00											40.00		120.00				28.00		70.00				40.00				40.00			1.33	0.93		1.33	0.93	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											88.23	44		44				64.17	32		32										44		44				32		32			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_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												
S4802	074	0		29	10	S4802_074_0	3	Preferred Generic	2	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	3	Generic	2	11	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	074	0		29	10	S4802_074_0	3	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					34.00		102.00											45.00		135.00				34.00		85.00				45.00				45.00			1.50	1.13		1.50	1.13	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.02	49		49				76.02	38		38										49		49				38		38			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_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												
S4802	075	0		29	10	S4802_075_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		27.50				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_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	075	0		29	10	S4802_075_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.28	48		48				84.80	41		41										48		48				41		41			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_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												
S4802	076	0		29	10	S4802_076_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					0.00		0.00											12.00		36.00				0.00		0.00				12.00				12.00			0.40	0.00		0.40	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	3	Generic	3	11	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	076	0		29	10	S4802_076_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	076	0		29	10	S4802_076_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.86	47		47				87.11	41		41										47		47				41		41			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_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												
S4802	077	0		29	10	S4802_077_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	3	Generic	3	11	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	077	0		29	10	S4802_077_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	077	0		29	10	S4802_077_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.36	45		45				90.53	41		41										45		45				41		41			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_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												
S4802	078	0		29	10	S4802_078_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		5.00				8.00				8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_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	078	0		29	10	S4802_078_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.92	46		46				89.40	42		42										46		46				42		42			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_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												
S4802	079	0		29	10	S4802_079_0	3	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				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												
S4802	079	0		29	10	S4802_079_0	3	Generic	3	11	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	079	0		29	10	S4802_079_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					41.00		123.00											47.00		141.00				41.00		102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.39	48		48				96.34	47		47										48		48				47		47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_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												
S4802	080	0		29	10	S4802_080_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					2.00		6.00											9.00		27.00				2.00		5.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_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	080	0		29	10	S4802_080_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.84	47		47				88.33	42		42										47		47				42		42			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_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												
S4802	081	0		29	10	S4802_081_0	3	Preferred Generic	2	11	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	081	0		29	10	S4802_081_0	3	Generic	2	11	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	081	0		29	10	S4802_081_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					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	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.70	46		46				85.82	40		40										46		46				40		40			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_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												
S4802	082	0		29	10	S4802_082_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	3	Generic	3	11	1	2	2	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		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												
S4802	082	0		29	10	S4802_082_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					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	082	0		29	10	S4802_082_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.89	50		50				79.11	40		40										50		50				40		40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_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												
S4802	083	0		29	10	S4802_083_0	3	Preferred Generic	2	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	3	Generic	2	11	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	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								45.00		135.00					34.00		102.00											45.00		135.00				34.00		85.00				45.00				45.00			1.50	1.13		1.50	1.13	1.45	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											99.29	48		48				78.61	38		38										48		48				38		38			48			48								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												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	3	Generic	3	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					10.00		30.00											19.00		57.00				10.00		25.00				19.00				19.00			0.63	0.33		0.63	0.33	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_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	084	0		29	10	S4802_084_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.11	47		47				86.46	41		41										47		47				41		41			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_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												
S4802	085	0		29	10	S4802_085_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	3	Generic	3	11	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	085	0		29	10	S4802_085_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	085	0		29	10	S4802_085_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.91	44		44				94.41	42		42										44		44				42		42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_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												
S4802	086	0		29	10	S4802_086_0	3	Preferred Generic	3	11	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	086	0		29	10	S4802_086_0	3	Generic	3	11	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	086	0		29	10	S4802_086_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	086	0		29	10	S4802_086_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.11	46		46				88.33	41		41										46		46				41		41			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_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												
S4802	087	0		29	10	S4802_087_0	3	Preferred Generic	2	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	3	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		5.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_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					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	087	0		29	10	S4802_087_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											96.21	50		50				75.04	39		39										50		50				39		39			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_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												
S4802	088	0		29	10	S4802_088_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	3	Generic	3	11	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	088	0		29	10	S4802_088_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					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	088	0		29	10	S4802_088_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.04	49		49				82.03	41		41										49		49				41		41			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_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												
S4802	089	0		29	10	S4802_089_0	3	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	0.00		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	11	1	2	2	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		7.50				10.00				10.00			0.33	0.10		0.33	0.10	0.32	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											96.53	50		50				77.22	40		40										50		50				40		40			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												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	3	Generic	3	11	1	2	2	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		10.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_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	090	0		29	10	S4802_090_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											90.36	50		50				72.28	40		40										50		50				40		40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_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												
S4802	091	0		29	10	S4802_091_0	3	Preferred Generic	2	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	3	Generic	2	11	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	091	0		29	10	S4802_091_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					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	091	0		29	10	S4802_091_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											93.88	46		46				73.48	36		36										46		46				36		36			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_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												
S4802	092	0		29	10	S4802_092_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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	4	Generic	3	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					7.00		21.00											13.00		39.00				7.00		17.50				13.00				13.00			0.43	0.23		0.43	0.23	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_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					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	4	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											92.77	50		50				74.21	40		40										50		50				40		40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_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												
S4802	093	0		29	10	S4802_093_0	3	Preferred Generic	2	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	3	Generic	2	11	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	093	0		29	10	S4802_093_0	3	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					30.00		90.00											45.00		135.00				30.00		75.00				45.00				45.00			1.50	1.00		1.50	1.00	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											90.63	46		46				70.93	36		36										46		46				36		36			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_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												
S4802	094	0		29	10	S4802_094_0	3	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	3	Generic	3	11	1	2	2	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		7.50				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_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	094	0		29	10	S4802_094_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.30	44		44				93.83	42		42										44		44				42		42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_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												
S4802	095	0		29	10	S4802_095_0	3	Preferred Generic	2	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	3	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		5.00				8.00				8.00			0.27	0.07		0.27	0.07	0.26	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					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	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											98.83	50		50				79.06	40		40										50		50				40		40			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												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	3	Preferred Generic	2	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	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	3	Generic	2	11	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	096	0		29	10	S4802_096_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					30.00		90.00											44.00		132.00				30.00		75.00				44.00				44.00			1.47	1.00		1.47	1.00	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.17	47		47				79.37	38		38										47		47				38		38			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_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												
S4802	097	0		29	10	S4802_097_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	3	Generic	3	11	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	097	0		29	10	S4802_097_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					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	097	0		29	10	S4802_097_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.22	48		48				99.22	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_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												
S4802	098	0		29	10	S4802_098_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	098	0		29	10	S4802_098_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	098	0		29	10	S4802_098_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					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	098	0		29	10	S4802_098_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											70.96	50		50				65.28	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	098	0		29	10	S4802_098_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												
S4802	099	0		29	10	S4802_099_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	099	0		29	10	S4802_099_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	099	0		29	10	S4802_099_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					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	099	0		29	10	S4802_099_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											76.15	50		50				70.06	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	099	0		29	10	S4802_099_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												
S4802	100	0		29	10	S4802_100_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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											76.10	50		50				70.01	46		46										50		50				46		46			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												33							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	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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											77.18	50		50				71.00	46		46										50		50				46		46			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												33							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	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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											68.90	50		50				63.39	46		46										50		50				46		46			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												33							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	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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											70.24	50		50				64.62	46		46										50		50				46		46			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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	104	0		29	10	S4802_104_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	104	0		29	10	S4802_104_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	104	0		29	10	S4802_104_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					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	104	0		29	10	S4802_104_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											69.59	50		50				64.02	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	104	0		29	10	S4802_104_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												
S4802	105	0		29	10	S4802_105_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	105	0		29	10	S4802_105_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	105	0		29	10	S4802_105_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					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	105	0		29	10	S4802_105_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											66.59	50		50				61.26	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	105	0		29	10	S4802_105_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												
S4802	106	0		29	10	S4802_106_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	106	0		29	10	S4802_106_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	106	0		29	10	S4802_106_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					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	106	0		29	10	S4802_106_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											70.10	50		50				64.49	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	106	0		29	10	S4802_106_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												
S4802	107	0		29	10	S4802_107_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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											63.81	50		50				58.71	46		46										50		50				46		46			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												33							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	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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											72.57	50		50				66.76	46		46										50		50				46		46			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												33							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	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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											73.56	50		50				67.68	46		46										50		50				46		46			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												33							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	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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											63.63	50		50				58.54	46		46										50		50				46		46			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												33							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	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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											71.97	50		50				66.21	46		46										50		50				46		46			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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	112	0		29	10	S4802_112_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	112	0		29	10	S4802_112_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	112	0		29	10	S4802_112_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					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	112	0		29	10	S4802_112_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.56	50		50				57.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	112	0		29	10	S4802_112_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												
S4802	113	0		29	10	S4802_113_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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											68.22	50		50				62.77	46		46										50		50				46		46			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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	114	0		29	10	S4802_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					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	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	114	0		29	10	S4802_114_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					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	114	0		29	10	S4802_114_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.45	50		50				57.45	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	114	0		29	10	S4802_114_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												
S4802	115	0		29	10	S4802_115_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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											62.21	50		50				57.24	46		46										50		50				46		46			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												33							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	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	0.00		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	11	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					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	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											61.17	50		50				56.27	46		46										50		50				46		46			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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	118	0		29	10	S4802_118_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	118	0		29	10	S4802_118_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	118	0		29	10	S4802_118_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					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	118	0		29	10	S4802_118_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											67.20	50		50				61.82	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	118	0		29	10	S4802_118_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												
S4802	119	0		29	10	S4802_119_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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											65.75	50		50				60.49	46		46										50		50				46		46			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												33							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	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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											68.97	50		50				63.45	46		46										50		50				46		46			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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	121	0		29	10	S4802_121_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	121	0		29	10	S4802_121_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	121	0		29	10	S4802_121_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					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	121	0		29	10	S4802_121_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											70.10	50		50				64.50	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	121	0		29	10	S4802_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												
S4802	122	0		29	10	S4802_122_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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											68.43	50		50				62.96	46		46										50		50				46		46			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												33							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	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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											67.54	50		50				62.13	46		46										50		50				46		46			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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	125	0		29	10	S4802_125_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	125	0		29	10	S4802_125_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	125	0		29	10	S4802_125_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					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	125	0		29	10	S4802_125_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.19	50		50				65.49	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	125	0		29	10	S4802_125_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												
S4802	127	0		29	10	S4802_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					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	11	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					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	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											67.10	50		50				61.73	46		46										50		50				46		46			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												33							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	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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											74.88	50		50				68.89	46		46										50		50				46		46			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												33							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	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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											70.21	50		50				64.59	46		46										50		50				46		46			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												33							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	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	0.00		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	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	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					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	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											71.49	50		50				65.77	46		46										50		50				46		46			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												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					8.00		24.00											11.00		33.00				8.00		20.00				11.00				11.00			0.37	0.27		0.37	0.27	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_0	5	Preferred Brand	4	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	132	0		29	10	S4802_132_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_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												
S4802	133	0		29	10	S4802_133_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	133	0		29	10	S4802_133_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					3.00		9.00											6.00		18.00				3.00		7.50				6.00				6.00			0.20	0.10		0.20	0.10	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	133	0		29	10	S4802_133_0	5	Preferred Brand	4	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	133	0		29	10	S4802_133_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	133	0		29	10	S4802_133_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												
S4802	134	0		29	10	S4802_134_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	134	0		29	10	S4802_134_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					10.00		30.00											13.00		39.00				10.00		25.00				13.00				13.00			0.43	0.33		0.43	0.33	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	134	0		29	10	S4802_134_0	5	Preferred Brand	4	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	134	0		29	10	S4802_134_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	134	0		29	10	S4802_134_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												
S4802	135	0		29	10	S4802_135_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	135	0		29	10	S4802_135_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					3.00		9.00											6.00		18.00				3.00		7.50				6.00				6.00			0.20	0.10		0.20	0.10	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	135	0		29	10	S4802_135_0	5	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		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	135	0		29	10	S4802_135_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.98	50		50				39.54	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	135	0		29	10	S4802_135_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												
S4802	136	0		29	10	S4802_136_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	136	0		29	10	S4802_136_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					6.00		18.00											9.00		27.00				6.00		15.00				9.00				9.00			0.30	0.20		0.30	0.20	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	136	0		29	10	S4802_136_0	5	Preferred Brand	4	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	136	0		29	10	S4802_136_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	136	0		29	10	S4802_136_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												
S4802	137	0		29	10	S4802_137_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	137	0		29	10	S4802_137_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					8.00		24.00											11.00		33.00				8.00		20.00				11.00				11.00			0.37	0.27		0.37	0.27	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	137	0		29	10	S4802_137_0	5	Preferred Brand	4	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	137	0		29	10	S4802_137_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	137	0		29	10	S4802_137_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												
S4802	138	0		29	10	S4802_138_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	138	0		29	10	S4802_138_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	138	0		29	10	S4802_138_0	5	Preferred Brand	4	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	138	0		29	10	S4802_138_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	138	0		29	10	S4802_138_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												
S4802	139	0		29	10	S4802_139_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	139	0		29	10	S4802_139_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	139	0		29	10	S4802_139_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					41.00		123.00											47.00		141.00				41.00		102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	139	0		29	10	S4802_139_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											40.45	50		50				38.83	48		48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	139	0		29	10	S4802_139_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												
S4802	140	0		29	10	S4802_140_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	140	0		29	10	S4802_140_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					8.00		24.00											11.00		33.00				8.00		20.00				11.00				11.00			0.37	0.27		0.37	0.27	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	140	0		29	10	S4802_140_0	5	Preferred Brand	4	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	140	0		29	10	S4802_140_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	140	0		29	10	S4802_140_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												
S4802	141	0		29	10	S4802_141_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	141	0		29	10	S4802_141_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	141	0		29	10	S4802_141_0	5	Preferred Brand	4	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	141	0		29	10	S4802_141_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	141	0		29	10	S4802_141_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												
S4802	142	0		29	10	S4802_142_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	142	0		29	10	S4802_142_0	5	Generic	4	11	1	2	2	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		17.50				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	142	0		29	10	S4802_142_0	5	Preferred Brand	4	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	142	0		29	10	S4802_142_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	142	0		29	10	S4802_142_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												
S4802	143	0		29	10	S4802_143_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	143	0		29	10	S4802_143_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					6.00		18.00											9.00		27.00				6.00		15.00				9.00				9.00			0.30	0.20		0.30	0.20	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	143	0		29	10	S4802_143_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					44.00		132.00											47.00		141.00				44.00		110.00				47.00				47.00			1.57	1.47		1.57	1.47	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	143	0		29	10	S4802_143_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.97	50		50				41.25	48		48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	143	0		29	10	S4802_143_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												
S4802	144	0		29	10	S4802_144_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	144	0		29	10	S4802_144_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					8.00		24.00											11.00		33.00				8.00		20.00				11.00				11.00			0.37	0.27		0.37	0.27	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	144	0		29	10	S4802_144_0	5	Preferred Brand	4	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	144	0		29	10	S4802_144_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	144	0		29	10	S4802_144_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												
S4802	145	0		29	10	S4802_145_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	145	0		29	10	S4802_145_0	5	Generic	4	11	1	2	2	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		17.50				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	145	0		29	10	S4802_145_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					39.00		117.00											47.00		141.00				39.00		97.50				47.00				47.00			1.57	1.30		1.57	1.30	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	145	0		29	10	S4802_145_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	145	0		29	10	S4802_145_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												
S4802	146	0		29	10	S4802_146_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	146	0		29	10	S4802_146_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					6.00		18.00											9.00		27.00				6.00		15.00				9.00				9.00			0.30	0.20		0.30	0.20	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	146	0		29	10	S4802_146_0	5	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		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												
S4802	146	0		29	10	S4802_146_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.97	50		50				39.53	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	146	0		29	10	S4802_146_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												
S4802	147	0		29	10	S4802_147_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	147	0		29	10	S4802_147_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	147	0		29	10	S4802_147_0	5	Preferred Brand	4	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	147	0		29	10	S4802_147_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	147	0		29	10	S4802_147_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												
S4802	148	0		29	10	S4802_148_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	148	0		29	10	S4802_148_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					6.00		18.00											9.00		27.00				6.00		15.00				9.00				9.00			0.30	0.20		0.30	0.20	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	148	0		29	10	S4802_148_0	5	Preferred Brand	4	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	148	0		29	10	S4802_148_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	148	0		29	10	S4802_148_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												
S4802	149	0		29	10	S4802_149_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	149	0		29	10	S4802_149_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	149	0		29	10	S4802_149_0	5	Preferred Brand	4	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	149	0		29	10	S4802_149_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	149	0		29	10	S4802_149_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												
S4802	150	0		29	10	S4802_150_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	150	0		29	10	S4802_150_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	150	0		29	10	S4802_150_0	5	Preferred Brand	4	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	150	0		29	10	S4802_150_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	150	0		29	10	S4802_150_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												
S4802	151	0		29	10	S4802_151_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	151	0		29	10	S4802_151_0	5	Generic	4	11	1	2	2	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		17.50				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	151	0		29	10	S4802_151_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	151	0		29	10	S4802_151_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.97	50		50				40.39	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	151	0		29	10	S4802_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												
S4802	152	0		29	10	S4802_152_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	152	0		29	10	S4802_152_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					6.00		18.00											9.00		27.00				6.00		15.00				9.00				9.00			0.30	0.20		0.30	0.20	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	152	0		29	10	S4802_152_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					41.00		123.00											47.00		141.00				41.00		102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	152	0		29	10	S4802_152_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.97	50		50				39.53	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	152	0		29	10	S4802_152_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												
S4802	153	0		29	10	S4802_153_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	153	0		29	10	S4802_153_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					3.00		9.00											6.00		18.00				3.00		7.50				6.00				6.00			0.20	0.10		0.20	0.10	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	153	0		29	10	S4802_153_0	5	Preferred Brand	4	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	153	0		29	10	S4802_153_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	153	0		29	10	S4802_153_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												
S4802	154	0		29	10	S4802_154_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	154	0		29	10	S4802_154_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					6.00		18.00											9.00		27.00				6.00		15.00				9.00				9.00			0.30	0.20		0.30	0.20	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	154	0		29	10	S4802_154_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					41.00		123.00											47.00		141.00				41.00		102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	154	0		29	10	S4802_154_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											40.46	50		50				37.22	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	154	0		29	10	S4802_154_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												
S4802	155	0		29	10	S4802_155_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	155	0		29	10	S4802_155_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	155	0		29	10	S4802_155_0	5	Preferred Brand	4	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	155	0		29	10	S4802_155_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											40.46	50		50				38.85	48		48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	155	0		29	10	S4802_155_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												
S4802	156	0		29	10	S4802_156_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	156	0		29	10	S4802_156_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	156	0		29	10	S4802_156_0	5	Preferred Brand	4	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	156	0		29	10	S4802_156_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	156	0		29	10	S4802_156_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												
S4802	157	0		29	10	S4802_157_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	157	0		29	10	S4802_157_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					4.00		12.00											7.00		21.00				4.00		10.00				7.00				7.00			0.23	0.13		0.23	0.13	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	157	0		29	10	S4802_157_0	5	Preferred Brand	4	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	157	0		29	10	S4802_157_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	157	0		29	10	S4802_157_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												
S4802	158	0		29	10	S4802_158_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	158	0		29	10	S4802_158_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					6.00		18.00											9.00		27.00				6.00		15.00				9.00				9.00			0.30	0.20		0.30	0.20	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	158	0		29	10	S4802_158_0	5	Preferred Brand	4	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	158	0		29	10	S4802_158_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	158	0		29	10	S4802_158_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												
S4802	159	0		29	10	S4802_159_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	159	0		29	10	S4802_159_0	5	Generic	4	11	1	2	2	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		17.50				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	159	0		29	10	S4802_159_0	5	Preferred Brand	4	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	159	0		29	10	S4802_159_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	159	0		29	10	S4802_159_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												
S4802	160	0		29	10	S4802_160_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	160	0		29	10	S4802_160_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					4.00		12.00											7.00		21.00				4.00		10.00				7.00				7.00			0.23	0.13		0.23	0.13	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	160	0		29	10	S4802_160_0	5	Preferred Brand	4	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	160	0		29	10	S4802_160_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.98	50		50				40.40	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	160	0		29	10	S4802_160_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												
S4802	161	0		29	10	S4802_161_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	161	0		29	10	S4802_161_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					4.00		12.00											7.00		21.00				4.00		10.00				7.00				7.00			0.23	0.13		0.23	0.13	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	161	0		29	10	S4802_161_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					39.00		117.00											47.00		141.00				39.00		97.50				47.00				47.00			1.57	1.30		1.57	1.30	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	161	0		29	10	S4802_161_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				40.41	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	161	0		29	10	S4802_161_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												
S4802	162	0		29	10	S4802_162_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	162	0		29	10	S4802_162_0	5	Generic	4	11	1	2	2	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		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												
S4802	162	0		29	10	S4802_162_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					38.00		114.00											47.00		141.00				38.00		95.00				47.00				47.00			1.57	1.27		1.57	1.27	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	162	0		29	10	S4802_162_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	162	0		29	10	S4802_162_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												
S4802	163	0		29	10	S4802_163_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	163	0		29	10	S4802_163_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					6.00		18.00											9.00		27.00				6.00		15.00				9.00				9.00			0.30	0.20		0.30	0.20	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	163	0		29	10	S4802_163_0	5	Preferred Brand	4	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	163	0		29	10	S4802_163_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	163	0		29	10	S4802_163_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												
S4802	164	0		29	10	S4802_164_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	164	0		29	10	S4802_164_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					8.00		24.00											11.00		33.00				8.00		20.00				11.00				11.00			0.37	0.27		0.37	0.27	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	164	0		29	10	S4802_164_0	5	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					41.00		123.00											47.00		141.00				41.00		102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	164	0		29	10	S4802_164_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.96	50		50				41.25	48		48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	164	0		29	10	S4802_164_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												
S4802	165	0		29	10	S4802_165_0	5	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				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 Drug, Specialty Tier												
S4802	165	0		29	10	S4802_165_0	5	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	165	0		29	10	S4802_165_0	5	Preferred Brand	4	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	165	0		29	10	S4802_165_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.99	50		50				39.55	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	165	0		29	10	S4802_165_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												
S4802	166	0		29	10	S4802_166_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	166	0		29	10	S4802_166_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	166	0		29	10	S4802_166_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					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	166	0		29	10	S4802_166_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											67.95	50		50				62.52	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	166	0		29	10	S4802_166_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												
S4802	167	0		29	10	S4802_167_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	167	0		29	10	S4802_167_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	167	0		29	10	S4802_167_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					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	167	0		29	10	S4802_167_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											67.95	50		50				62.52	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	167	0		29	10	S4802_167_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												
S4802	168	0		29	10	S4802_168_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	168	0		29	10	S4802_168_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	168	0		29	10	S4802_168_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					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	168	0		29	10	S4802_168_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											67.95	50		50				62.52	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	168	0		29	10	S4802_168_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												
S4802	169	0		29	10	S4802_169_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	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	169	0		29	10	S4802_169_0	3	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	169	0		29	10	S4802_169_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					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	169	0		29	10	S4802_169_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											67.95	50		50				62.52	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	169	0		29	10	S4802_169_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												
S5540	002	0		29	10	S5540_002_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	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												
S5540	002	0		29	10	S5540_002_0	2	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 Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	2	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 Drug, Specialty Tier												
S5540	002	0		29	10	S5540_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		31											92.23	50	50	50				92.23	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											921.01	25						921.01	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_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	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 Drug, Specialty Tier												
S5540	004	0		29	10	S5540_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	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 Drug, Specialty Tier										1		
S5540	004	0		29	10	S5540_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	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 Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	2	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 Drug, Specialty Tier												
S5540	004	0		29	10	S5540_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											59.42	50	50	50				59.42	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1074.10	33						1074.10	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	003	0		29	10	S5552_003_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																									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												
S5552	003	0		29	10	S5552_003_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	003	0		29	10	S5552_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	3	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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	003	0		29	10	S5552_003_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												
S5552	004	0		29	10	S5552_004_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5552	004	0		29	10	S5552_004_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				33.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				68.00	34		34																								34		34				34		30			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_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												
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	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											34.00	25		25				26.00	20		20										25		25				20		11			25			25								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											73.00	44		44				55.00	35		35										44		44				35		30			44			44								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	3	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	3	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	3	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	3	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											44.00	50		50				44.00	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	3	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	3	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	3	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	3	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	3	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				42.00	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	3	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												
S5584	005	0		29	10	S5584_005_0	3	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												
S5584	005	0		29	10	S5584_005_0	3	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												
S5584	005	0		29	10	S5584_005_0	3	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												
S5584	005	0		29	10	S5584_005_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											43.00	50		50				43.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	005	0		29	10	S5584_005_0	3	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	4	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	4	Generic	2	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								12.00		36.00					7.00		21.00													30.00						17.50				12.00				12.00			0.39	0.23				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	4	Preferred Brand	2	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											40.49	25		25				40.49	20		20												25						20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											65.30	50		50				65.30	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	4	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31											937.89	25						937.89	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	4	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	4	Preferred Generic	4	01	1	1	1	3		110	01		100	1				31		90	1	2						90	31		31											1.53	17		17				1.53	12		12												17						12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5593	003	0		29	10	S5593_003_0	4	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	4	Generic	4	01	1	1	2	3		110	01		100	1				31		90	1	2						90	31		31											6.42	17		17				6.42	12		12												17						12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5593	003	0		29	10	S5593_003_0	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											64.87	50		50				64.87	35		35												50						35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	4	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1214.93	33						1214.93	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	2.00	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	2.00	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	6.00	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	80.00	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											60.86	47	47	47				50.50	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	005	0		29	10	S5596_005_0	3	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	2.00	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	005	0		29	10	S5596_005_0	3	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	10.00	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	005	0		29	10	S5596_005_0	3	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	60.00	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	005	0		29	10	S5596_005_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											72.99	50	50	50				58.39	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	3	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	3	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	2.00	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	2.00	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	6.00	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	80.00	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											56.77	47	47	47				47.10	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	009	0		29	10	S5596_009_0	2	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	2.00	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	2	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	10.00	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	009	0		29	10	S5596_009_0	2	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			1.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	009	0		29	10	S5596_009_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											72.81	50	50	50				58.25	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	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	009	0		29	10	S5596_009_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	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	2.00	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	2.00	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	6.00	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	80.00	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											60.12	47	47	47				49.89	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	013	0		29	10	S5596_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								13.00	26.00	39.00					1.00	2.00	3.00					1.00	2.00	3.00																13.00				13.00			0.43	0.03	0.03			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	013	0		29	10	S5596_013_0	2	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	10.00	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	013	0		29	10	S5596_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								40.00	80.00	120.00					30.00	60.00	90.00					30.00	60.00	90.00																40.00				40.00			1.33	1.00	1.00			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	013	0		29	10	S5596_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											76.20	50	50	50				60.96	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	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	013	0		29	10	S5596_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								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	2.00	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	2.00	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	6.00	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	80.00	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											64.60	47	47	47				53.60	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	017	0		29	10	S5596_017_0	2	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	2.00	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	2	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	10.00	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	017	0		29	10	S5596_017_0	2	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	60.00	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	2	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											72.14	50	50	50				57.71	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	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	017	0		29	10	S5596_017_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	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	2.00	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	2.00	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	6.00	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	80.00	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											55.52	47	47	47				46.07	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	033	0		29	10	S5596_033_0	2	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					1.00	2.00	3.00					1.00	2.00	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	033	0		29	10	S5596_033_0	2	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	10.00	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	033	0		29	10	S5596_033_0	2	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	60.00	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	033	0		29	10	S5596_033_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											87.92	48	48	48				73.27	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	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	033	0		29	10	S5596_033_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	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	2.00	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	2.00	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	6.00	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	80.00	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											65.39	43	43	43				57.78	38	38	38				38	38	38															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	043	0		29	10	S5596_043_0	2	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	2.00	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	2	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					5.00	10.00	15.00					5.00	10.00	15.00																13.00				13.00			0.43	0.17	0.17			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_0	2	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			1.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_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											64.65	47	47	47				55.03	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	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	043	0		29	10	S5596_043_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	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	2.00	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	2.00	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	6.00	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	80.00	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											57.29	47	47	47				47.54	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	046	0		29	10	S5596_046_0	2	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	2.00	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	046	0		29	10	S5596_046_0	2	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	10.00	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	046	0		29	10	S5596_046_0	2	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	60.00	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	046	0		29	10	S5596_046_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											82.04	50	50	50				65.63	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	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	046	0		29	10	S5596_046_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								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	2	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	2.00	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	056	0		29	10	S5596_056_0	2	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	10.00	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	056	0		29	10	S5596_056_0	2	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	60.00	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	056	0		29	10	S5596_056_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											67.92	43	43	43				63.18	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	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	056	0		29	10	S5596_056_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	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	2.00	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	2.00	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	6.00	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	80.00	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											57.25	47	47	47				47.50	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	059	0		29	10	S5596_059_0	2	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					1.00	2.00	3.00					1.00	2.00	3.00																13.00				13.00			0.43	0.03	0.03			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_0	2	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	10.00	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	059	0		29	10	S5596_059_0	2	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								40.00	80.00	120.00					30.00	60.00	90.00					30.00	60.00	90.00																40.00				40.00			1.33	1.00	1.00			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_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											75.74	50	50	50				60.59	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	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	059	0		29	10	S5596_059_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	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	2.00	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	2.00	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	6.00	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	80.00	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											61.50	43	43	43				55.78	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	062	0		29	10	S5596_062_0	2	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	2.00	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	062	0		29	10	S5596_062_0	2	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	10.00	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	062	0		29	10	S5596_062_0	2	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	60.00	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	062	0		29	10	S5596_062_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											80.58	50	50	50				64.47	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	062	0		29	10	S5596_062_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	062	0		29	10	S5596_062_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												
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	2.00	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	2.00	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	6.00	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	80.00	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											56.70	47	47	47				47.05	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		
S5601	002	0		29	10	S5601_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								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	3	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											20.00	40.00	60.00				15.00	30.00	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												
S5601	002	0		29	10	S5601_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					44.00	88.00	132.00											47.00	94.00	141.00				44.00	88.00	110.00				47.00				47.00			1.57	1.47		1.57	1.47	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											90.56	50	50	50				85.13	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	3	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											944.36	33						944.36	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				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		
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		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	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		31											87.54	50	50	50				70.04	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		31											810.79	33						810.79	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	30.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	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		31								47.00	94.00	141.00					38.00	76.00	114.00											47.00	94.00	141.00				38.00	76.00	95.00				47.00				47.00			1.57	1.27		1.57	1.27	1.52	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		31											92.19	50	50	50				70.06	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		31											825.88	33						825.88	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											93.73	50	50	50				74.98	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		31											832.93	33						832.93	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	2	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					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	2	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					13.00	26.00	39.00											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	2	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_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											92.74	50	50	50				83.46	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											778.34	33						778.34	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											101.31	50	50	50				81.05	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		31											889.58	33						889.58	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					14.00	28.00	42.00											20.00	40.00	60.00				14.00	28.00	35.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	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		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	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		31											94.38	50	50	50				88.72	47	47	47										50	50	50				47	47	47			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		31											840.77	33						840.77	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											96.12	50	50	50				76.89	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		31											1117.16	33						1117.16	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		31								10.00	20.00	30.00					9.00	18.00	27.00											10.00	20.00	30.00				9.00	18.00	0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	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		31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	47.50				20.00				20.00			0.67	0.63		0.67	0.63	0.65	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		31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	115.00				47.00				47.00			1.57	1.53		1.57	1.53	1.52	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		31											85.69	50	50	50				83.97	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		31											863.43	33						863.43	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											86.73	50	50	50				69.38	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		31											891.03	33						891.03	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					14.00	28.00	42.00											20.00	40.00	60.00				14.00	28.00	35.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	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		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	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		31											91.48	50	50	50				78.67	43	43	43										50	50	50				43	43	43			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		31											909.29	33						909.29	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											84.27	50	50	50				67.42	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		31											835.05	33						835.05	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		31								10.00	20.00	30.00					9.00	18.00	27.00											10.00	20.00	30.00				9.00	18.00	0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	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		31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	47.50				20.00				20.00			0.67	0.63		0.67	0.63	0.65	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		31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	115.00				47.00				47.00			1.57	1.53		1.57	1.53	1.52	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		31											88.10	50	50	50				86.34	49	49	49										50	50	50				49	49	49			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		31											923.34	33						923.34	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											84.15	50	50	50				67.32	40	40	40										50	50	50				40	40	40			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		31											939.64	33						939.64	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					18.00	36.00	54.00											20.00	40.00	60.00				18.00	36.00	45.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	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		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	112.50				47.00				47.00			1.57	1.50		1.57	1.50	1.52	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		31											89.83	50	50	50				88.03	49	49	49										50	50	50				49	49	49			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		31											897.48	33						897.48	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											83.27	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	017	0		29	10	S5601_017_0	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											998.56	33						998.56	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		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	12.50				15.00				15.00			0.50	0.17		0.50	0.17	0.48	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		31								35.00	70.00	105.00					20.00	40.00	60.00											35.00	70.00	105.00				20.00	40.00	50.00				35.00				35.00			1.17	0.67		1.17	0.67	1.13	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		31											65.00	40	40	40				56.88	35	35	35										40	40	40				35	35	35			40			40								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		31											688.02	25						688.02	25												25						25					25			25								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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					33.00	66.00	99.00											47.00	94.00	141.00				33.00	66.00	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												
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		31											80.91	50	50	50				64.73	40	40	40										50	50	50				40	40	40			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		31											951.55	33						951.55	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					13.00	26.00	39.00											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.65	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		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	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		31											77.42	50	50	50				65.03	42	42	42										50	50	50				42	42	42			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		31											794.83	31						794.83	31												31						31					31			31								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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											79.76	50	50	50				63.81	40	40	40										50	50	50				40	40	40			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		31											824.73	33						824.73	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2	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					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2	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					17.00	34.00	51.00											20.00	40.00	60.00				17.00	34.00	42.50				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	2	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					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	112.50				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_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											89.16	50	50	50				87.38	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	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											818.81	33						818.81	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											93.64	50	50	50				74.91	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		31											960.47	33						960.47	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		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				20.00			0.67	0.50		0.67	0.50	0.65	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		31								47.00	94.00	141.00					44.00	88.00	132.00											47.00	94.00	141.00				44.00	88.00	110.00				47.00				47.00			1.57	1.47		1.57	1.47	1.52	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		31											87.29	50	50	50				82.06	47	47	47										50	50	50				47	47	47			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		31											982.04	33						982.04	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											83.90	50	50	50				67.12	40	40	40										50	50	50				40	40	40			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		31											890.11	33						890.11	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	30.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	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		31								47.00	94.00	141.00					39.00	78.00	117.00											47.00	94.00	141.00				39.00	78.00	97.50				47.00				47.00			1.57	1.30		1.57	1.30	1.52	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		31											105.67	50	50	50				82.42	39	39	39										50	50	50				39	39	39			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		31											992.56	33						992.56	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											92.23	50	50	50				73.78	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		31											932.77	33						932.77	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					16.00	32.00	48.00											20.00	40.00	60.00				16.00	32.00	40.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	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		31								47.00	94.00	141.00					44.00	88.00	132.00											47.00	94.00	141.00				44.00	88.00	110.00				47.00				47.00			1.57	1.47		1.57	1.47	1.52	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		31											97.97	50	50	50				92.09	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		31											896.32	33						896.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											86.71	50	50	50				69.36	40	40	40										50	50	50				40	40	40			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		31											828.60	33						828.60	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					13.00	26.00	39.00											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.65	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		31								47.00	94.00	141.00					41.00	82.00	123.00											47.00	94.00	141.00				41.00	82.00	102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.52	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		31											95.58	50	50	50				84.11	44	44	44										50	50	50				44	44	44			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		31											908.46	33						908.46	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											83.28	50	50	50				66.63	40	40	40										50	50	50				40	40	40			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		31											982.75	33						982.75	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	25.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	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		31								47.00	94.00	141.00					34.00	68.00	102.00											47.00	94.00	141.00				34.00	68.00	85.00				47.00				47.00			1.57	1.13		1.57	1.13	1.52	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		31											93.52	49	49	49				64.89	34	34	34										49	49	49				34	34	34			49			49								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		31											926.33	33						926.33	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					33.00	66.00	99.00											47.00	94.00	141.00				33.00	66.00	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												
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		31											80.35	50	50	50				64.28	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		31											834.09	33						834.09	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		31								10.00	20.00	30.00					9.00	18.00	27.00											10.00	20.00	30.00				9.00	18.00	0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	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		31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	47.50				20.00				20.00			0.67	0.63		0.67	0.63	0.65	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		31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	115.00				47.00				47.00			1.57	1.53		1.57	1.53	1.52	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		31											94.73	50	50	50				92.83	49	49	49										50	50	50				49	49	49			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		31											919.20	33						919.20	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											94.19	50	50	50				75.35	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		31											959.00	33						959.00	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	30.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	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		31								47.00	94.00	141.00					41.00	82.00	123.00											47.00	94.00	141.00				41.00	82.00	102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.52	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		31											94.51	50	50	50				77.50	41	41	41										50	50	50				41	41	41			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		31											908.14	33						908.14	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											81.97	50	50	50				65.58	40	40	40										50	50	50				40	40	40			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		31											892.66	33						892.66	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					13.00	26.00	39.00											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.65	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		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	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		31											82.26	50	50	50				75.68	46	46	46										50	50	50				46	46	46			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		31											1095.82	33						1095.82	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					18.00	36.00	54.00											20.00	40.00	60.00				18.00	36.00	45.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	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		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	112.50				47.00				47.00			1.57	1.50		1.57	1.50	1.52	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		31											88.41	50	50	50				86.65	49	49	49										50	50	50				49	49	49			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		31											992.66	33						992.66	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											77.68	50	50	50				62.15	40	40	40										50	50	50				40	40	40			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		31											1011.41	33						1011.41	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	30.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	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		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	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		31											88.03	50	50	50				73.95	42	42	42										50	50	50				42	42	42			50			50								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		31											824.80	33						824.80	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					13.00	26.00	39.00											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.65	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		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	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		31											93.63	50	50	50				78.65	42	42	42										50	50	50				42	42	42			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		31											836.49	31						836.49	31												31						31					31			31								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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											90.68	50	50	50				72.54	40	40	40										50	50	50				40	40	40			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		31											843.67	33						843.67	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	30.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	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		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	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		31											95.38	50	50	50				80.12	42	42	42										50	50	50				42	42	42			50			50								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		31											1062.31	33						1062.31	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					13.00	26.00	39.00											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.65	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		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	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		31											93.41	50	50	50				80.33	43	43	43										50	50	50				43	43	43			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		31											1062.56	33						1062.56	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											81.97	50	50	50				65.57	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		31											886.74	33						886.74	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	30.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	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		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	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		31											90.86	50	50	50				78.14	43	43	43										50	50	50				43	43	43			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		31											953.68	33						953.68	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											82.13	50	50	50				65.70	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		31											1125.29	33						1125.29	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		31								8.00	16.00	24.00					7.00	14.00	21.00											8.00	16.00	24.00				7.00	14.00	0.00				8.00				8.00			0.27	0.23		0.27	0.23	0.26	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		31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	47.50				20.00				20.00			0.67	0.63		0.67	0.63	0.65	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		31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	115.00				47.00				47.00			1.57	1.53		1.57	1.53	1.52	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		31											79.87	50	50	50				78.27	49	49	49										50	50	50				49	49	49			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		31											1082.60	33						1082.60	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	0.00				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		
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		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	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		31											84.20	50	50	50				67.36	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		31											1150.12	33						1150.12	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					14.00	28.00	42.00											20.00	40.00	60.00				14.00	28.00	35.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	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		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	141.00				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	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		31											80.81	50	50	50				75.96	47	47	47										50	50	50				47	47	47			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		31											897.45	31						897.45	31												31						31					31			31								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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											91.09	50	50	50				72.87	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		31											877.47	33						877.47	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		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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		31								14.00	28.00	42.00					5.00	10.00	15.00											14.00	28.00	42.00				5.00	10.00	12.50				14.00				14.00			0.47	0.17		0.47	0.17	0.45	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		31								34.00	68.00	102.00					19.00	38.00	57.00											34.00	68.00	102.00				19.00	38.00	47.50				34.00				34.00			1.13	0.63		1.13	0.63	1.10	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		31											63.46	39	39	39				55.33	34	34	34										39	39	39				34	34	34			39			39								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		31											723.96	25						723.96	25												25						25					25			25								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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					31.00	62.00	93.00											47.00	94.00	141.00				31.00	62.00	77.50				47.00				47.00			1.57	1.03		1.57	1.03	1.52	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		31											76.35	50	50	50				61.08	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		31											1035.73	33						1035.73	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	2	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					9.00	18.00	27.00											10.00	20.00	30.00				9.00	18.00	0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	2	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					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	47.50				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	2	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					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	115.00				47.00				47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_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											95.09	50	50	50				93.19	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	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											998.42	33						998.42	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											81.76	50	50	50				65.40	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		31											826.29	33						826.29	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								19.00	38.00	57.00					10.00	20.00	30.00											19.00	38.00	57.00				10.00	20.00	25.00				19.00				19.00			0.63	0.33		0.63	0.33	0.61	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		31								46.00	92.00	138.00					34.00	68.00	102.00											46.00	92.00	138.00				34.00	68.00	85.00				46.00				46.00			1.53	1.13		1.53	1.13	1.48	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		31											82.05	49	49	49				56.93	34	34	34										49	49	49				34	34	34			49			49								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		31											991.62	33						991.62	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					33.00	66.00	99.00											47.00	94.00	141.00				33.00	66.00	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												
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		31											79.78	50	50	50				63.82	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		31											829.02	33						829.02	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					14.00	28.00	42.00											20.00	40.00	60.00				14.00	28.00	35.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	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		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	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		31											100.23	50	50	50				90.21	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		31											961.16	33						961.16	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											86.96	50	50	50				69.57	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		31											851.22	33						851.22	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		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	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		31								20.00	40.00	60.00					13.00	26.00	39.00											20.00	40.00	60.00				13.00	26.00	32.50				20.00				20.00			0.67	0.43		0.67	0.43	0.65	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		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	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		31											103.41	50	50	50				93.07	45	45	45										50	50	50				45	45	45			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		31											899.54	33						899.54	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											98.10	50	50	50				78.48	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		31											809.39	33						809.39	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		31								10.00	20.00	30.00					9.00	18.00	27.00											10.00	20.00	30.00				9.00	18.00	0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	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		31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	47.50				20.00				20.00			0.67	0.63		0.67	0.63	0.65	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		31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	115.00				47.00				47.00			1.57	1.53		1.57	1.53	1.52	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		31											105.98	50	50	50				103.86	49	49	49										50	50	50				49	49	49			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		31											1015.66	33						1015.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	1	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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	1	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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	067	0		29	10	S5601_067_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	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	1	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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	067	0		29	10	S5601_067_0	1	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					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	067	0		29	10	S5601_067_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											88.15	50	50	50				70.52	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	1	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											896.34	33						896.34	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		31	1.00	2.00	3.00																			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		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 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		31				14.19	18	18	18																		18	18	18															18			18								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		31				60.32	37	37	37																		37	37	37															37			37								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		31				683.64	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											72.04	50	50	50				57.63	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		31											1122.30	33						1122.30	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	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		31											85.41	50	50	50				68.32	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		31											762.24	33						762.24	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	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		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	87.50				47.00				47.00			1.57	1.17		1.57	1.17	1.52	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		31											82.04	50	50	50				65.63	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		31											936.78	33						936.78	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	143	0		29	10	S5601_143_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	143	0		29	10	S5601_143_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	143	0		29	10	S5601_143_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	143	0		29	10	S5601_143_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	143	0		29	10	S5601_143_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	144	0		29	10	S5601_144_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	144	0		29	10	S5601_144_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	144	0		29	10	S5601_144_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	144	0		29	10	S5601_144_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	144	0		29	10	S5601_144_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	145	0		29	10	S5601_145_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	145	0		29	10	S5601_145_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	145	0		29	10	S5601_145_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	145	0		29	10	S5601_145_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	145	0		29	10	S5601_145_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	146	0		29	10	S5601_146_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	146	0		29	10	S5601_146_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	146	0		29	10	S5601_146_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	146	0		29	10	S5601_146_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	146	0		29	10	S5601_146_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	147	0		29	10	S5601_147_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	147	0		29	10	S5601_147_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	147	0		29	10	S5601_147_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	147	0		29	10	S5601_147_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	147	0		29	10	S5601_147_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	148	0		29	10	S5601_148_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	148	0		29	10	S5601_148_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	148	0		29	10	S5601_148_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	148	0		29	10	S5601_148_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	148	0		29	10	S5601_148_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	149	0		29	10	S5601_149_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	149	0		29	10	S5601_149_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	149	0		29	10	S5601_149_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	149	0		29	10	S5601_149_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	149	0		29	10	S5601_149_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	150	0		29	10	S5601_150_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	150	0		29	10	S5601_150_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	150	0		29	10	S5601_150_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	150	0		29	10	S5601_150_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	150	0		29	10	S5601_150_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	151	0		29	10	S5601_151_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	151	0		29	10	S5601_151_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	151	0		29	10	S5601_151_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	151	0		29	10	S5601_151_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	151	0		29	10	S5601_151_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	152	0		29	10	S5601_152_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	152	0		29	10	S5601_152_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	152	0		29	10	S5601_152_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	152	0		29	10	S5601_152_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	152	0		29	10	S5601_152_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	153	0		29	10	S5601_153_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	153	0		29	10	S5601_153_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	153	0		29	10	S5601_153_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	153	0		29	10	S5601_153_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	153	0		29	10	S5601_153_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	154	0		29	10	S5601_154_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	154	0		29	10	S5601_154_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	154	0		29	10	S5601_154_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	154	0		29	10	S5601_154_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	154	0		29	10	S5601_154_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	155	0		29	10	S5601_155_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	155	0		29	10	S5601_155_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	155	0		29	10	S5601_155_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	155	0		29	10	S5601_155_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	155	0		29	10	S5601_155_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	156	0		29	10	S5601_156_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	156	0		29	10	S5601_156_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	156	0		29	10	S5601_156_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	156	0		29	10	S5601_156_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	156	0		29	10	S5601_156_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	157	0		29	10	S5601_157_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	157	0		29	10	S5601_157_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	157	0		29	10	S5601_157_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	157	0		29	10	S5601_157_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	157	0		29	10	S5601_157_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	158	0		29	10	S5601_158_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	158	0		29	10	S5601_158_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	158	0		29	10	S5601_158_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	158	0		29	10	S5601_158_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	158	0		29	10	S5601_158_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	159	0		29	10	S5601_159_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	159	0		29	10	S5601_159_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	159	0		29	10	S5601_159_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	159	0		29	10	S5601_159_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	159	0		29	10	S5601_159_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	160	0		29	10	S5601_160_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	160	0		29	10	S5601_160_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	160	0		29	10	S5601_160_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	160	0		29	10	S5601_160_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	160	0		29	10	S5601_160_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	161	0		29	10	S5601_161_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	161	0		29	10	S5601_161_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	161	0		29	10	S5601_161_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	161	0		29	10	S5601_161_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	161	0		29	10	S5601_161_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	162	0		29	10	S5601_162_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	162	0		29	10	S5601_162_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	162	0		29	10	S5601_162_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	162	0		29	10	S5601_162_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	162	0		29	10	S5601_162_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	163	0		29	10	S5601_163_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	163	0		29	10	S5601_163_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	163	0		29	10	S5601_163_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	163	0		29	10	S5601_163_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	163	0		29	10	S5601_163_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	164	0		29	10	S5601_164_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	164	0		29	10	S5601_164_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	164	0		29	10	S5601_164_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	164	0		29	10	S5601_164_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	164	0		29	10	S5601_164_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	165	0		29	10	S5601_165_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	165	0		29	10	S5601_165_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	165	0		29	10	S5601_165_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	165	0		29	10	S5601_165_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	165	0		29	10	S5601_165_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	166	0		29	10	S5601_166_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	166	0		29	10	S5601_166_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	166	0		29	10	S5601_166_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	166	0		29	10	S5601_166_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	166	0		29	10	S5601_166_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	167	0		29	10	S5601_167_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	167	0		29	10	S5601_167_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	167	0		29	10	S5601_167_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	167	0		29	10	S5601_167_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	167	0		29	10	S5601_167_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	168	0		29	10	S5601_168_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	168	0		29	10	S5601_168_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	168	0		29	10	S5601_168_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	168	0		29	10	S5601_168_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	168	0		29	10	S5601_168_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	169	0		29	10	S5601_169_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	169	0		29	10	S5601_169_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	169	0		29	10	S5601_169_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	169	0		29	10	S5601_169_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	169	0		29	10	S5601_169_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	170	0		29	10	S5601_170_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	170	0		29	10	S5601_170_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	170	0		29	10	S5601_170_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	170	0		29	10	S5601_170_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	170	0		29	10	S5601_170_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	171	0		29	10	S5601_171_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	171	0		29	10	S5601_171_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	171	0		29	10	S5601_171_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	171	0		29	10	S5601_171_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	171	0		29	10	S5601_171_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	172	0		29	10	S5601_172_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	172	0		29	10	S5601_172_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	172	0		29	10	S5601_172_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	172	0		29	10	S5601_172_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	172	0		29	10	S5601_172_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	173	0		29	10	S5601_173_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	173	0		29	10	S5601_173_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	173	0		29	10	S5601_173_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	173	0		29	10	S5601_173_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	173	0		29	10	S5601_173_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	174	0		29	10	S5601_174_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	174	0		29	10	S5601_174_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	174	0		29	10	S5601_174_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	174	0		29	10	S5601_174_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	174	0		29	10	S5601_174_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	175	0		29	10	S5601_175_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					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	175	0		29	10	S5601_175_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					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	175	0		29	10	S5601_175_0	3	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											28.92	25	25	25				23.14	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	175	0		29	10	S5601_175_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											75.99	50	50	50				60.79	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	175	0		29	10	S5601_175_0	3	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.04	33						955.04	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								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												
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								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												
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					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												
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											89.55	45	45	45				79.60	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											1449.00	30						1449.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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 Drug, Specialty Tier												
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	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 Drug, Specialty Tier										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	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												
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	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												
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				79.60	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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				1593.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	6	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	6	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	6	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								34.00	68.00	102.00					30.00	60.00	90.00											34.00	68.00	102.00				30.00	60.00	90.00				34.00				34.00			1.13	1.00		1.13	1.00	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	6	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											71.25	45	45	45				52.42	38	38	38										45	45	45				38	38	38			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	6	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	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	008	0		29	10	S5617_008_0	5	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	5	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								34.00	68.00	102.00					30.00	60.00	90.00											34.00	68.00	102.00				30.00	60.00	90.00				34.00				34.00			1.13	1.00		1.13	1.00	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											59.82	41	41	41				48.47	36	36	36										41	41	41				36	36	36			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	008	0		29	10	S5617_008_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	013	0		29	10	S5617_013_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	013	0		29	10	S5617_013_0	5	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	5	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								34.00	68.00	102.00					30.00	60.00	90.00											34.00	68.00	102.00				30.00	60.00	90.00				34.00				34.00			1.13	1.00		1.13	1.00	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											59.66	40	40	40				49.62	36	36	36										40	40	40				36	36	36			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	013	0		29	10	S5617_013_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	018	0		29	10	S5617_018_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	018	0		29	10	S5617_018_0	5	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	5	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								32.00	64.00	96.00					30.00	60.00	90.00											32.00	64.00	96.00				30.00	60.00	90.00				32.00				32.00			1.07	1.00		1.07	1.00	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											53.72	36	36	36				48.30	35	35	35										36	36	36				35	35	35			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	018	0		29	10	S5617_018_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	053	0		29	10	S5617_053_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	053	0		29	10	S5617_053_0	5	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	5	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								32.00	64.00	96.00					30.00	60.00	90.00											32.00	64.00	96.00				30.00	60.00	90.00				32.00				32.00			1.07	1.00		1.07	1.00	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											45.86	36	36	36				42.81	35	35	35										36	36	36				35	35	35			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	053	0		29	10	S5617_053_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	068	0		29	10	S5617_068_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	068	0		29	10	S5617_068_0	5	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	5	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								32.00	64.00	96.00					30.00	60.00	90.00											32.00	64.00	96.00				30.00	60.00	90.00				32.00				32.00			1.07	1.00		1.07	1.00	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											51.93	36	36	36				44.96	35	35	35										36	36	36				35	35	35			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	068	0		29	10	S5617_068_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	088	0		29	10	S5617_088_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	088	0		29	10	S5617_088_0	5	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	5	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								32.00	64.00	96.00					30.00	60.00	90.00											32.00	64.00	96.00				30.00	60.00	90.00				32.00				32.00			1.07	1.00		1.07	1.00	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.70	41	41	41				39.75	36	36	36										41	41	41				36	36	36			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	088	0		29	10	S5617_088_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	103	0		29	10	S5617_103_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	103	0		29	10	S5617_103_0	5	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	5	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					30.00	60.00	90.00											31.00	62.00	93.00				30.00	60.00	90.00				31.00				31.00			1.03	1.00		1.03	1.00	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											40.16	36	36	36				33.11	34	34	34										36	36	36				34	34	34			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	103	0		29	10	S5617_103_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	108	0		29	10	S5617_108_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	108	0		29	10	S5617_108_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					30.00	60.00	90.00											31.00	62.00	93.00				30.00	60.00	90.00				31.00				31.00			1.03	1.00		1.03	1.00	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.05	41	41	41				54.96	37	37	37										41	41	41				37	37	37			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	108	0		29	10	S5617_108_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	113	0		29	10	S5617_113_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	113	0		29	10	S5617_113_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					30.00	60.00	90.00											31.00	62.00	93.00				30.00	60.00	90.00				31.00				31.00			1.03	1.00		1.03	1.00	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											52.66	35	35	35				46.74	33	33	33										35	35	35				33	33	33			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	113	0		29	10	S5617_113_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	118	0		29	10	S5617_118_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	118	0		29	10	S5617_118_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								34.00	68.00	102.00					30.00	60.00	90.00											34.00	68.00	102.00				30.00	60.00	90.00				34.00				34.00			1.13	1.00		1.13	1.00	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											60.96	44	44	44				42.97	38	38	38										44	44	44				38	38	38			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	118	0		29	10	S5617_118_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	123	0		29	10	S5617_123_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	123	0		29	10	S5617_123_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					30.00	60.00	90.00											31.00	62.00	93.00				30.00	60.00	90.00				31.00				31.00			1.03	1.00		1.03	1.00	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											53.26	38	38	38				48.10	36	36	36										38	38	38				36	36	36			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	123	0		29	10	S5617_123_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	128	0		29	10	S5617_128_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	128	0		29	10	S5617_128_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	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	128	0		29	10	S5617_128_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								36.00	72.00	108.00					30.00	60.00	90.00											36.00	72.00	108.00				30.00	60.00	90.00				36.00				36.00			1.20	1.00		1.20	1.00	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											72.68	50	50	50				53.78	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	128	0		29	10	S5617_128_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	133	0		29	10	S5617_133_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	133	0		29	10	S5617_133_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	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	133	0		29	10	S5617_133_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								34.00	68.00	102.00					30.00	60.00	90.00											34.00	68.00	102.00				30.00	60.00	90.00				34.00				34.00			1.13	1.00		1.13	1.00	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											70.56	43	43	43				44.05	38	38	38										43	43	43				38	38	38			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	133	0		29	10	S5617_133_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	138	0		29	10	S5617_138_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	138	0		29	10	S5617_138_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								34.00	68.00	102.00					30.00	60.00	90.00											34.00	68.00	102.00				30.00	60.00	90.00				34.00				34.00			1.13	1.00		1.13	1.00	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											56.10	42	42	42				42.57	37	37	37										42	42	42				37	37	37			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	138	0		29	10	S5617_138_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	143	0		29	10	S5617_143_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	143	0		29	10	S5617_143_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					30.00	60.00	90.00											31.00	62.00	93.00				30.00	60.00	90.00				31.00				31.00			1.03	1.00		1.03	1.00	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											54.94	37	37	37				44.34	35	35	35										37	37	37				35	35	35			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	143	0		29	10	S5617_143_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	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	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	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	148	0		29	10	S5617_148_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											66.05	41	41	41				53.61	37	37	37										41	41	41				37	37	37			41			41								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	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	153	0		29	10	S5617_153_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					30.00	60.00	90.00											31.00	62.00	93.00				30.00	60.00	90.00				31.00				31.00			1.03	1.00		1.03	1.00	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											51.59	39	39	39				42.89	35	35	35										39	39	39				35	35	35			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	153	0		29	10	S5617_153_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	158	0		29	10	S5617_158_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	158	0		29	10	S5617_158_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								32.00	64.00	96.00					30.00	60.00	90.00											32.00	64.00	96.00				30.00	60.00	90.00				32.00				32.00			1.07	1.00		1.07	1.00	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											54.92	33	33	33				48.30	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	158	0		29	10	S5617_158_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	163	0		29	10	S5617_163_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	163	0		29	10	S5617_163_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								32.00	64.00	96.00					30.00	60.00	90.00											32.00	64.00	96.00				30.00	60.00	90.00				32.00				32.00			1.07	1.00		1.07	1.00	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											65.06	40	40	40				53.38	36	36	36										40	40	40				36	36	36			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	163	0		29	10	S5617_163_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	214	0		29	10	S5617_214_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	214	0		29	10	S5617_214_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					30.00	60.00	90.00											31.00	62.00	93.00				30.00	60.00	90.00				31.00				31.00			1.03	1.00		1.03	1.00	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											64.19	41	41	41				53.11	37	37	37										41	41	41				37	37	37			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	214	0		29	10	S5617_214_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	215	0		29	10	S5617_215_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	215	0		29	10	S5617_215_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	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	215	0		29	10	S5617_215_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											59.41	41	41	41				46.43	36	36	36										41	41	41				36	36	36			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	215	0		29	10	S5617_215_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	216	0		29	10	S5617_216_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	216	0		29	10	S5617_216_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	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	216	0		29	10	S5617_216_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	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	216	0		29	10	S5617_216_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											60.85	43	43	43				47.26	37	37	37										43	43	43				37	37	37			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	216	0		29	10	S5617_216_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	217	0		29	10	S5617_217_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	217	0		29	10	S5617_217_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	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	217	0		29	10	S5617_217_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								36.00	72.00	108.00					30.00	60.00	90.00											36.00	72.00	108.00				30.00	60.00	90.00				36.00				36.00			1.20	1.00		1.20	1.00	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											59.98	43	43	43				43.07	36	36	36										43	43	43				36	36	36			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	217	0		29	10	S5617_217_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	218	0		29	10	S5617_218_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	218	0		29	10	S5617_218_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	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	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											55.41	43	43	43				40.56	37	37	37										43	43	43				37	37	37			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	218	0		29	10	S5617_218_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	219	0		29	10	S5617_219_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	219	0		29	10	S5617_219_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					30.00	60.00	90.00											31.00	62.00	93.00				30.00	60.00	90.00				31.00				31.00			1.03	1.00		1.03	1.00	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											42.81	41	41	41				34.21	37	37	37										41	41	41				37	37	37			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	219	0		29	10	S5617_219_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	220	0		29	10	S5617_220_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	220	0		29	10	S5617_220_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		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												
S5617	220	0		29	10	S5617_220_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											53.84	35	35	35				47.10	35	35	35										35	35	35				35	35	35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	220	0		29	10	S5617_220_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	221	0		29	10	S5617_221_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	221	0		29	10	S5617_221_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					30.00	60.00	90.00											31.00	62.00	93.00				30.00	60.00	90.00				31.00				31.00			1.03	1.00		1.03	1.00	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											62.43	40	40	40				51.69	36	36	36										40	40	40				36	36	36			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	221	0		29	10	S5617_221_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	222	0		29	10	S5617_222_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	222	0		29	10	S5617_222_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								34.00	68.00	102.00					30.00	60.00	90.00											34.00	68.00	102.00				30.00	60.00	90.00				34.00				34.00			1.13	1.00		1.13	1.00	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											62.81	43	43	43				45.52	36	36	36										43	43	43				36	36	36			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	222	0		29	10	S5617_222_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	223	0		29	10	S5617_223_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	223	0		29	10	S5617_223_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					30.00	60.00	90.00											31.00	62.00	93.00				30.00	60.00	90.00				31.00				31.00			1.03	1.00		1.03	1.00	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											59.10	38	38	38				50.40	35	35	35										38	38	38				35	35	35			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	223	0		29	10	S5617_223_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	224	0		29	10	S5617_224_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	224	0		29	10	S5617_224_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					30.00	60.00	90.00											31.00	62.00	93.00				30.00	60.00	90.00				31.00				31.00			1.03	1.00		1.03	1.00	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											64.30	42	42	42				48.06	36	36	36										42	42	42				36	36	36			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	224	0		29	10	S5617_224_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	225	0		29	10	S5617_225_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	225	0		29	10	S5617_225_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								34.00	68.00	102.00					30.00	60.00	90.00											34.00	68.00	102.00				30.00	60.00	90.00				34.00				34.00			1.13	1.00		1.13	1.00	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											66.59	45	45	45				47.78	40	40	40										45	45	45				40	40	40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	225	0		29	10	S5617_225_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	226	0		29	10	S5617_226_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	226	0		29	10	S5617_226_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	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	226	0		29	10	S5617_226_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											62.93	48	48	48				45.43	42	42	42										48	48	48				42	42	42			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	226	0		29	10	S5617_226_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	227	0		29	10	S5617_227_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	227	0		29	10	S5617_227_0	4	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	4	Preferred Brand	2	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								31.00	62.00	93.00					30.00	60.00	90.00											31.00	62.00	93.00				30.00	60.00	90.00				31.00				31.00			1.03	1.00		1.03	1.00	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											48.64	40	40	40				43.96	36	36	36										40	40	40				36	36	36			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	227	0		29	10	S5617_227_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	246	0		29	10	S5617_246_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	5	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	246	0		29	10	S5617_246_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	5	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	246	0		29	10	S5617_246_0	5	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											63.31	50	50	50				54.58	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	5	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												
S5617	246	0		29	10	S5617_246_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	247	0		29	10	S5617_247_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	247	0		29	10	S5617_247_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											60.32	50	50	50				54.25	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_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												
S5617	247	0		29	10	S5617_247_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	248	0		29	10	S5617_248_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	248	0		29	10	S5617_248_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											58.62	50	50	50				50.53	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_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												
S5617	248	0		29	10	S5617_248_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	249	0		29	10	S5617_249_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	249	0		29	10	S5617_249_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											54.48	50	50	50				49.06	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_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												
S5617	249	0		29	10	S5617_249_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	250	0		29	10	S5617_250_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	250	0		29	10	S5617_250_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											48.81	50	50	50				43.38	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_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												
S5617	250	0		29	10	S5617_250_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	251	0		29	10	S5617_251_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	251	0		29	10	S5617_251_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											51.91	50	50	50				46.05	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_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												
S5617	251	0		29	10	S5617_251_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	252	0		29	10	S5617_252_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	252	0		29	10	S5617_252_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.61	50	50	50				45.51	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_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												
S5617	252	0		29	10	S5617_252_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	253	0		29	10	S5617_253_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	253	0		29	10	S5617_253_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											55.07	50	50	50				45.04	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_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												
S5617	253	0		29	10	S5617_253_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	254	0		29	10	S5617_254_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	254	0		29	10	S5617_254_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											53.34	50	50	50				43.27	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_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												
S5617	254	0		29	10	S5617_254_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	255	0		29	10	S5617_255_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	255	0		29	10	S5617_255_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											47.49	50	50	50				42.38	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_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												
S5617	255	0		29	10	S5617_255_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	256	0		29	10	S5617_256_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	256	0		29	10	S5617_256_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											55.33	50	50	50				48.66	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_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												
S5617	256	0		29	10	S5617_256_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	257	0		29	10	S5617_257_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	257	0		29	10	S5617_257_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.54	50	50	50				42.46	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_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												
S5617	257	0		29	10	S5617_257_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	258	0		29	10	S5617_258_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	258	0		29	10	S5617_258_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.59	50	50	50				44.16	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_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												
S5617	258	0		29	10	S5617_258_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	259	0		29	10	S5617_259_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	259	0		29	10	S5617_259_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											52.80	50	50	50				42.44	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_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												
S5617	259	0		29	10	S5617_259_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	260	0		29	10	S5617_260_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	260	0		29	10	S5617_260_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											49.06	50	50	50				40.87	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_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												
S5617	260	0		29	10	S5617_260_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	261	0		29	10	S5617_261_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	261	0		29	10	S5617_261_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											54.89	50	50	50				45.96	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_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												
S5617	261	0		29	10	S5617_261_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	262	0		29	10	S5617_262_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	262	0		29	10	S5617_262_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											57.51	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, Select Care Drugs												
S5617	262	0		29	10	S5617_262_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												
S5617	262	0		29	10	S5617_262_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	263	0		29	10	S5617_263_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	263	0		29	10	S5617_263_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											53.46	50	50	50				45.33	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_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												
S5617	263	0		29	10	S5617_263_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	264	0		29	10	S5617_264_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	264	0		29	10	S5617_264_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											46.15	50	50	50				38.71	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_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												
S5617	264	0		29	10	S5617_264_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	265	0		29	10	S5617_265_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	265	0		29	10	S5617_265_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											45.14	50	50	50				38.37	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_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												
S5617	265	0		29	10	S5617_265_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	266	0		29	10	S5617_266_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	266	0		29	10	S5617_266_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											47.91	50	50	50				41.36	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_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												
S5617	266	0		29	10	S5617_266_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	267	0		29	10	S5617_267_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	267	0		29	10	S5617_267_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											63.70	50	50	50				50.66	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_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												
S5617	267	0		29	10	S5617_267_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	5	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	268	0		29	10	S5617_268_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	5	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	268	0		29	10	S5617_268_0	5	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											48.21	50	50	50				46.31	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	5	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												
S5617	268	0		29	10	S5617_268_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	269	0		29	10	S5617_269_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	269	0		29	10	S5617_269_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.53	50	50	50				46.46	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_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												
S5617	269	0		29	10	S5617_269_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	270	0		29	10	S5617_270_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	270	0		29	10	S5617_270_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											54.38	50	50	50				49.83	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_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												
S5617	270	0		29	10	S5617_270_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	271	0		29	10	S5617_271_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	271	0		29	10	S5617_271_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											53.86	50	50	50				49.43	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_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												
S5617	271	0		29	10	S5617_271_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	272	0		29	10	S5617_272_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	272	0		29	10	S5617_272_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											54.65	50	50	50				45.54	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_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												
S5617	272	0		29	10	S5617_272_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	273	0		29	10	S5617_273_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	273	0		29	10	S5617_273_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											51.31	50	50	50				41.58	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_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												
S5617	273	0		29	10	S5617_273_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	274	0		29	10	S5617_274_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	274	0		29	10	S5617_274_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											48.42	50	50	50				41.88	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_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												
S5617	274	0		29	10	S5617_274_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	275	0		29	10	S5617_275_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	275	0		29	10	S5617_275_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											57.62	50	50	50				49.15	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_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												
S5617	275	0		29	10	S5617_275_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	276	0		29	10	S5617_276_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	276	0		29	10	S5617_276_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											56.11	50	50	50				48.78	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_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												
S5617	276	0		29	10	S5617_276_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	5	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	277	0		29	10	S5617_277_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	5	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	277	0		29	10	S5617_277_0	5	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											75.52	50	50	50				58.33	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	5	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												
S5617	277	0		29	10	S5617_277_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	278	0		29	10	S5617_278_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	278	0		29	10	S5617_278_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											57.47	50	50	50				51.20	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_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												
S5617	278	0		29	10	S5617_278_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_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					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	4	Preferred Generic	4	01	1	2	1	3		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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	279	0		29	10	S5617_279_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	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, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	4	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	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	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, Select Care Drugs										1		
S5617	279	0		29	10	S5617_279_0	4	Preferred Brand	4	11	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											47.00	94.00	141.00				42.00	84.00	105.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											51.45	50	50	50				46.80	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_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												
S5617	279	0		29	10	S5617_279_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								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	15.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	280	0		29	10	S5617_280_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	280	0		29	10	S5617_280_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					3.00	6.00	9.00											17.00	34.00	51.00				3.00	6.00	6.00				17.00				17.00			0.57	0.10		0.57	0.10	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	280	0		29	10	S5617_280_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											44.16	20	20	20				42.67	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	280	0		29	10	S5617_280_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.77	50	50	50				43.50	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	280	0		29	10	S5617_280_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												
S5617	281	0		29	10	S5617_281_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	281	0		29	10	S5617_281_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					3.00	6.00	9.00											9.00	18.00	27.00				3.00	6.00	6.00				9.00				9.00			0.30	0.10		0.30	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	281	0		29	10	S5617_281_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											44.28	20	20	20				41.55	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	281	0		29	10	S5617_281_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											51.24	50	50	50				42.51	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	281	0		29	10	S5617_281_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												
S5617	282	0		29	10	S5617_282_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	282	0		29	10	S5617_282_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								11.00	22.00	33.00					3.00	6.00	9.00											11.00	22.00	33.00				3.00	6.00	6.00				11.00				11.00			0.37	0.10		0.37	0.10	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	282	0		29	10	S5617_282_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											45.52	20	20	20				42.94	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	282	0		29	10	S5617_282_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											52.10	50	50	50				44.19	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	282	0		29	10	S5617_282_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												
S5617	283	0		29	10	S5617_283_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	283	0		29	10	S5617_283_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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 Drug, Specialty Tier												
S5617	283	0		29	10	S5617_283_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											46.03	20	20	20				44.21	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	283	0		29	10	S5617_283_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											51.89	50	50	50				44.63	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	283	0		29	10	S5617_283_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												
S5617	284	0		29	10	S5617_284_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	284	0		29	10	S5617_284_0	4	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					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	6.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	284	0		29	10	S5617_284_0	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											44.74	20	20	20				42.32	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	284	0		29	10	S5617_284_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.23	50	50	50				42.57	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	284	0		29	10	S5617_284_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												
S5617	285	0		29	10	S5617_285_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	285	0		29	10	S5617_285_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	6.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	285	0		29	10	S5617_285_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											45.74	20	20	20				42.94	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	285	0		29	10	S5617_285_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											51.26	50	50	50				42.63	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	285	0		29	10	S5617_285_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												
S5617	286	0		29	10	S5617_286_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	286	0		29	10	S5617_286_0	4	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					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	6.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	286	0		29	10	S5617_286_0	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											44.83	20	20	20				42.95	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	286	0		29	10	S5617_286_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											51.36	50	50	50				43.89	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	286	0		29	10	S5617_286_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												
S5617	287	0		29	10	S5617_287_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	287	0		29	10	S5617_287_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					3.00	6.00	9.00											17.00	34.00	51.00				3.00	6.00	6.00				17.00				17.00			0.57	0.10		0.57	0.10	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	287	0		29	10	S5617_287_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.50	20	20	20				40.61	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	287	0		29	10	S5617_287_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											49.92	50	50	50				39.67	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	287	0		29	10	S5617_287_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												
S5617	288	0		29	10	S5617_288_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	288	0		29	10	S5617_288_0	4	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					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	6.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	288	0		29	10	S5617_288_0	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											45.77	20	20	20				41.00	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	288	0		29	10	S5617_288_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.83	50	50	50				41.72	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	288	0		29	10	S5617_288_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												
S5617	289	0		29	10	S5617_289_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	289	0		29	10	S5617_289_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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 Drug, Specialty Tier												
S5617	289	0		29	10	S5617_289_0	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.30	20	20	20				41.93	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	289	0		29	10	S5617_289_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											46.17	50	50	50				42.31	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	289	0		29	10	S5617_289_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												
S5617	290	0		29	10	S5617_290_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	290	0		29	10	S5617_290_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	39.00					3.00	6.00	9.00											13.00	26.00	39.00				3.00	6.00	6.00				13.00				13.00			0.43	0.10		0.43	0.10	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	290	0		29	10	S5617_290_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											44.26	20	20	20				41.96	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	290	0		29	10	S5617_290_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.20	50	50	50				42.72	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	290	0		29	10	S5617_290_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												
S5617	291	0		29	10	S5617_291_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	291	0		29	10	S5617_291_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					3.00	6.00	9.00											19.00	38.00	57.00				3.00	6.00	6.00				19.00				19.00			0.63	0.10		0.63	0.10	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	291	0		29	10	S5617_291_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.58	20	20	20				41.50	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	291	0		29	10	S5617_291_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											49.09	50	50	50				40.79	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	291	0		29	10	S5617_291_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												
S5617	292	0		29	10	S5617_292_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	292	0		29	10	S5617_292_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								18.00	36.00	54.00					3.00	6.00	9.00											18.00	36.00	54.00				3.00	6.00	6.00				18.00				18.00			0.60	0.10		0.60	0.10	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	292	0		29	10	S5617_292_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											44.71	20	20	20				41.62	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	292	0		29	10	S5617_292_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											49.98	50	50	50				40.75	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	292	0		29	10	S5617_292_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												
S5617	293	0		29	10	S5617_293_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	293	0		29	10	S5617_293_0	5	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					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	6.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	293	0		29	10	S5617_293_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											44.59	20	20	20				41.04	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	293	0		29	10	S5617_293_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.99	50	50	50				40.59	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	293	0		29	10	S5617_293_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												
S5617	294	0		29	10	S5617_294_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	294	0		29	10	S5617_294_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	6.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	294	0		29	10	S5617_294_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.01	20	20	20				39.39	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	294	0		29	10	S5617_294_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											48.43	50	50	50				38.29	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	294	0		29	10	S5617_294_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												
S5617	295	0		29	10	S5617_295_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	295	0		29	10	S5617_295_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	39.00					3.00	6.00	9.00											13.00	26.00	39.00				3.00	6.00	6.00				13.00				13.00			0.43	0.10		0.43	0.10	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	295	0		29	10	S5617_295_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.49	20	20	20				40.03	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	295	0		29	10	S5617_295_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											48.22	50	50	50				39.62	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	295	0		29	10	S5617_295_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												
S5617	296	0		29	10	S5617_296_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	296	0		29	10	S5617_296_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								16.00	32.00	48.00					3.00	6.00	9.00											16.00	32.00	48.00				3.00	6.00	6.00				16.00				16.00			0.53	0.10		0.53	0.10	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	296	0		29	10	S5617_296_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											44.26	20	20	20				41.07	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	296	0		29	10	S5617_296_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.51	50	50	50				39.88	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	296	0		29	10	S5617_296_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												
S5617	297	0		29	10	S5617_297_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	297	0		29	10	S5617_297_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	6.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	297	0		29	10	S5617_297_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.24	20	20	20				39.66	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	297	0		29	10	S5617_297_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											48.53	50	50	50				38.61	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	297	0		29	10	S5617_297_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												
S5617	298	0		29	10	S5617_298_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	298	0		29	10	S5617_298_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	39.00					3.00	6.00	9.00											13.00	26.00	39.00				3.00	6.00	6.00				13.00				13.00			0.43	0.10		0.43	0.10	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	298	0		29	10	S5617_298_0	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											41.04	20	20	20				38.82	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	298	0		29	10	S5617_298_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											44.10	50	50	50				37.98	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	298	0		29	10	S5617_298_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												
S5617	299	0		29	10	S5617_299_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	299	0		29	10	S5617_299_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								16.00	32.00	48.00					3.00	6.00	9.00											16.00	32.00	48.00				3.00	6.00	6.00				16.00				16.00			0.53	0.10		0.53	0.10	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	299	0		29	10	S5617_299_0	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											41.20	20	20	20				39.84	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	299	0		29	10	S5617_299_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											44.94	50	50	50				39.10	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	299	0		29	10	S5617_299_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												
S5617	300	0		29	10	S5617_300_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	300	0		29	10	S5617_300_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	6.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	300	0		29	10	S5617_300_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											42.98	20	20	20				41.05	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	300	0		29	10	S5617_300_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											48.10	50	50	50				39.00	48	48	48										50	50	50				48	48	48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	300	0		29	10	S5617_300_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												
S5617	301	0		29	10	S5617_301_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	301	0		29	10	S5617_301_0	4	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					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	6.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	301	0		29	10	S5617_301_0	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											44.52	20	20	20				41.71	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	301	0		29	10	S5617_301_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.82	50	50	50				41.37	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	301	0		29	10	S5617_301_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												
S5617	302	0		29	10	S5617_302_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	302	0		29	10	S5617_302_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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 Drug, Specialty Tier												
S5617	302	0		29	10	S5617_302_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											40.19	20	20	20				39.38	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	302	0		29	10	S5617_302_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.97	50	50	50				38.18	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	302	0		29	10	S5617_302_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												
S5617	303	0		29	10	S5617_303_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	303	0		29	10	S5617_303_0	4	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								11.00	22.00	33.00					3.00	6.00	9.00											11.00	22.00	33.00				3.00	6.00	6.00				11.00				11.00			0.37	0.10		0.37	0.10	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	303	0		29	10	S5617_303_0	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											42.94	20	20	20				38.82	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	303	0		29	10	S5617_303_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											45.37	50	50	50				38.79	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	303	0		29	10	S5617_303_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												
S5617	304	0		29	10	S5617_304_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	304	0		29	10	S5617_304_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								11.00	22.00	33.00					3.00	6.00	9.00											11.00	22.00	33.00				3.00	6.00	6.00				11.00				11.00			0.37	0.10		0.37	0.10	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	304	0		29	10	S5617_304_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											42.38	20	20	20				40.61	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	304	0		29	10	S5617_304_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											47.17	50	50	50				38.70	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	304	0		29	10	S5617_304_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												
S5617	305	0		29	10	S5617_305_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	305	0		29	10	S5617_305_0	4	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					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	6.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	305	0		29	10	S5617_305_0	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											46.65	20	20	20				41.43	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	305	0		29	10	S5617_305_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											47.51	50	50	50				43.60	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	305	0		29	10	S5617_305_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												
S5617	306	0		29	10	S5617_306_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	306	0		29	10	S5617_306_0	4	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					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	6.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	306	0		29	10	S5617_306_0	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											45.71	20	20	20				41.80	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	306	0		29	10	S5617_306_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.70	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	306	0		29	10	S5617_306_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												
S5617	307	0		29	10	S5617_307_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	307	0		29	10	S5617_307_0	4	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					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	6.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	307	0		29	10	S5617_307_0	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											46.95	20	20	20				41.83	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	307	0		29	10	S5617_307_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											52.24	50	50	50				42.18	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	307	0		29	10	S5617_307_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												
S5617	308	0		29	10	S5617_308_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	308	0		29	10	S5617_308_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	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	6.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	308	0		29	10	S5617_308_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.17	20	20	20				39.34	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	308	0		29	10	S5617_308_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											48.25	50	50	50				38.42	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	308	0		29	10	S5617_308_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												
S5617	309	0		29	10	S5617_309_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	309	0		29	10	S5617_309_0	4	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					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	6.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	309	0		29	10	S5617_309_0	4	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											44.75	20	20	20				40.65	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	309	0		29	10	S5617_309_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											49.43	50	50	50				41.50	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	309	0		29	10	S5617_309_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												
S5617	310	0		29	10	S5617_310_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	310	0		29	10	S5617_310_0	5	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					3.00	6.00	9.00											14.00	28.00	42.00				3.00	6.00	6.00				14.00				14.00			0.47	0.10		0.47	0.10	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	310	0		29	10	S5617_310_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											42.67	20	20	20				40.25	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	310	0		29	10	S5617_310_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											46.35	50	50	50				38.46	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	310	0		29	10	S5617_310_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												
S5617	311	0		29	10	S5617_311_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	311	0		29	10	S5617_311_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					3.00	6.00	9.00											9.00	18.00	27.00				3.00	6.00	6.00				9.00				9.00			0.30	0.10		0.30	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	311	0		29	10	S5617_311_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											46.07	20	20	20				41.16	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	311	0		29	10	S5617_311_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											51.90	50	50	50				40.40	47	47	47										50	50	50				47	47	47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	311	0		29	10	S5617_311_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												
S5617	312	0		29	10	S5617_312_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	312	0		29	10	S5617_312_0	5	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					3.00	6.00	9.00											14.00	28.00	42.00				3.00	6.00	6.00				14.00				14.00			0.47	0.10		0.47	0.10	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	312	0		29	10	S5617_312_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											46.16	20	20	20				42.97	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	312	0		29	10	S5617_312_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											47.77	50	50	50				43.32	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	312	0		29	10	S5617_312_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												
S5617	313	0		29	10	S5617_313_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											6.00	12.00	18.00				1.00	2.00	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												
S5617	313	0		29	10	S5617_313_0	5	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					3.00	6.00	9.00											9.00	18.00	27.00				3.00	6.00	6.00				9.00				9.00			0.30	0.10		0.30	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	313	0		29	10	S5617_313_0	5	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.56	20	20	20				42.01	20	20	20										20	20	20				20	20	20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	313	0		29	10	S5617_313_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											48.21	50	50	50				41.79	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	313	0		29	10	S5617_313_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												
S5660	104	0		29	10	S5660_104_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											50.00	46						45.79	44												48						46					46			46								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								36.00		108.00					26.00		78.00													78.00						78.00				36.00				36.00			1.20	0.87				1.16	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				30								30			30		31											62.33	40						54.29	38												42						40					40			40								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											55.15	38						51.44	36												40						38					38			38								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											65.22	44						58.07	42												46						44					44			44								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								36.00		108.00					26.00		78.00													78.00						78.00				36.00				36.00			1.20	0.87				1.16	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				30								30			30		31											50.13	37						46.12	35												39						37					37			37								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											56.07	38						51.11	36												40						38					38			38								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											66.95	45						56.62	43												47						45					45			45								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											57.74	50						45.73	48												52						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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											50.55	47						42.01	45												49						47					47			47								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											59.89	42						56.86	40												44						42					42			42								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											47.61	43						43.28	41												45						43					43			43								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											54.75	42						48.49	40												44						42					42			42								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											50.15	46						44.96	44												48						46					46			46								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								36.00		108.00					26.00		78.00													78.00						78.00				36.00				36.00			1.20	0.87				1.16	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				30								30			30		31											49.13	41						44.02	39												43						41					41			41								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											66.41	46						54.52	44												48						46					46			46								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								46.00		138.00					36.00		108.00													108.00						108.00				46.00				46.00			1.53	1.20				1.48	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				30								30			30		31											57.85	50						48.05	48												52						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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											54.04	47						43.64	45												49						47					47			47								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											50.16	50						40.31	48												52						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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								39.00		117.00					29.00		87.00													87.00						87.00				39.00				39.00			1.30	0.97				1.26	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				30								30			30		31											52.94	50						42.11	48												52						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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											50.12	39						45.83	37												41						39					39			39								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											54.21	50						45.35	48												52						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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											49.47	40						42.09	38												42						40					40			40								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								41.00		123.00					31.00		93.00													93.00						93.00				41.00				41.00			1.37	1.03				1.32	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				30								30			30		31											48.15	50						39.19	48												52						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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								40.00		120.00					30.00		90.00													90.00						90.00				40.00				40.00			1.33	1.00				1.29	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				30								30			30		31											57.33	50						43.00	48												52						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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								43.00		129.00					33.00		99.00													99.00						99.00				43.00				43.00			1.43	1.10				1.39	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				30								30			30		31											56.93	50						49.28	48												52						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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								39.00		117.00					29.00		87.00													87.00						87.00				39.00				39.00			1.30	0.97				1.26	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				30								30			30		31											63.53	50						54.60	48												52						50					50			50								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											84.08	50						61.85	48												52						50					50			50								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													96.00						96.00				42.00				42.00			1.40	1.07				1.35	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				30								30			30		31											53.48	50						42.71	48												52						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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											57.75	44						52.91	42												46						44					44			44								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											62.16	41						50.60	39												43						41					41			41								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											56.09	46						52.31	44												48						46					46			46								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											76.48	38						70.33	36												40						38					38			38								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											51.13	43						48.44	41												45						43					43			43								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								41.00		123.00					31.00		93.00													93.00						93.00				41.00				41.00			1.37	1.03				1.32	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				30								30			30		31											49.13	50						47.16	48												52						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				30								30			30		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	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											149.98	50		50				135.04	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	172	0		29	10	S5660_172_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											87.41	50						77.64	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	172	0		29	10	S5660_172_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												
S5660	176	0		29	10	S5660_176_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											148.24	50		50				135.02	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	176	0		29	10	S5660_176_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											83.10	50						79.46	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	176	0		29	10	S5660_176_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												
S5660	180	0		29	10	S5660_180_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											145.70	50		50				132.89	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	180	0		29	10	S5660_180_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											73.68	50						69.25	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	180	0		29	10	S5660_180_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												
S5660	181	0		29	10	S5660_181_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											144.28	50		50				132.24	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	181	0		29	10	S5660_181_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.42	38						94.31	36												40						38					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	181	0		29	10	S5660_181_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												
S5660	182	0		29	10	S5660_182_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											146.30	50		50				135.60	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	182	0		29	10	S5660_182_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											91.72	50						81.79	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	182	0		29	10	S5660_182_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												
S5660	183	0		29	10	S5660_183_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											150.77	50		50				135.89	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	183	0		29	10	S5660_183_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.79	42						94.08	40												44						42					42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	183	0		29	10	S5660_183_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												
S5660	184	0		29	10	S5660_184_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											149.31	50		50				135.92	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	184	0		29	10	S5660_184_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											84.07	50						77.24	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	184	0		29	10	S5660_184_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												
S5660	185	0		29	10	S5660_185_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											144.38	50		50				130.30	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	185	0		29	10	S5660_185_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											89.19	50						82.10	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	185	0		29	10	S5660_185_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												
S5660	186	0		29	10	S5660_186_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	3	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	186	0		29	10	S5660_186_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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	3	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											148.57	50		50				134.70	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	186	0		29	10	S5660_186_0	3	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.12	47						95.89	45												49						47					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	186	0		29	10	S5660_186_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												
S5660	187	0		29	10	S5660_187_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											149.62	50		50				137.93	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	187	0		29	10	S5660_187_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											91.80	50						84.56	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	187	0		29	10	S5660_187_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												
S5660	190	0		29	10	S5660_190_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											145.61	50		50				132.94	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	190	0		29	10	S5660_190_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											86.36	50						80.56	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	190	0		29	10	S5660_190_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												
S5660	192	0		29	10	S5660_192_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											144.69	50		50				130.68	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	192	0		29	10	S5660_192_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											86.57	50						82.21	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	192	0		29	10	S5660_192_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												
S5660	194	0		29	10	S5660_194_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											145.16	50		50				130.94	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	194	0		29	10	S5660_194_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											91.58	50						81.18	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	194	0		29	10	S5660_194_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												
S5660	195	0		29	10	S5660_195_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											146.92	50		50				133.45	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	195	0		29	10	S5660_195_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											81.20	50						76.98	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	195	0		29	10	S5660_195_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												
S5660	196	0		29	10	S5660_196_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											153.56	50		50				137.48	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	196	0		29	10	S5660_196_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.80	49						92.18	47												51						49					49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	196	0		29	10	S5660_196_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												
S5660	197	0		29	10	S5660_197_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											145.19	50		50				131.28	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	197	0		29	10	S5660_197_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.52	41						95.27	39												43						41					41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	197	0		29	10	S5660_197_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												
S5660	198	0		29	10	S5660_198_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											146.40	50		50				131.30	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	198	0		29	10	S5660_198_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											92.85	50						87.87	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	198	0		29	10	S5660_198_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												
S5660	199	0		29	10	S5660_199_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											151.20	50		50				136.28	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	199	0		29	10	S5660_199_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											90.37	50						86.54	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	199	0		29	10	S5660_199_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												
S5660	202	0		29	10	S5660_202_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											151.05	50		50				136.25	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	202	0		29	10	S5660_202_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.60	47						94.09	45												49						47					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	202	0		29	10	S5660_202_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												
S5660	203	0		29	10	S5660_203_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											150.13	50		50				135.46	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	203	0		29	10	S5660_203_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.76	46						90.16	44												48						46					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	203	0		29	10	S5660_203_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												
S5660	204	0		29	10	S5660_204_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											141.09	50		50				130.58	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	204	0		29	10	S5660_204_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.56	45						93.69	43												47						45					45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	204	0		29	10	S5660_204_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												
S5660	206	0		29	10	S5660_206_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											163.91	50		50				149.74	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	206	0		29	10	S5660_206_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.46	50						92.48	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	206	0		29	10	S5660_206_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												
S5660	207	0		29	10	S5660_207_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											153.29	50		50				136.74	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	207	0		29	10	S5660_207_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.26	43						93.86	41												45						43					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	207	0		29	10	S5660_207_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												
S5660	208	0		29	10	S5660_208_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											153.73	50		50				139.45	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	208	0		29	10	S5660_208_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											85.90	50						80.33	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	208	0		29	10	S5660_208_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												
S5660	209	0		29	10	S5660_209_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											154.16	50		50				140.71	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	209	0		29	10	S5660_209_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											86.44	50						79.90	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	209	0		29	10	S5660_209_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												
S5660	210	0		29	10	S5660_210_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											155.59	50		50				141.30	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	210	0		29	10	S5660_210_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											87.86	50						83.05	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	210	0		29	10	S5660_210_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												
S5660	211	0		29	10	S5660_211_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											149.90	50		50				136.42	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	211	0		29	10	S5660_211_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											83.71	50						78.94	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	211	0		29	10	S5660_211_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												
S5660	212	0		29	10	S5660_212_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											151.33	50		50				136.32	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	212	0		29	10	S5660_212_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											85.32	50						81.58	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	212	0		29	10	S5660_212_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												
S5660	213	0		29	10	S5660_213_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											146.01	50		50				135.05	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	213	0		29	10	S5660_213_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.72	50						94.81	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	213	0		29	10	S5660_213_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												
S5660	214	0		29	10	S5660_214_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											145.43	50		50				133.83	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	214	0		29	10	S5660_214_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.00	48						93.18	46												50						48					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	214	0		29	10	S5660_214_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												
S5660	215	0		29	10	S5660_215_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											154.92	50		50				140.40	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	215	0		29	10	S5660_215_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.52	48						90.30	46												50						48					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	215	0		29	10	S5660_215_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												
S5660	216	0		29	10	S5660_216_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											144.52	50		50				136.96	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	216	0		29	10	S5660_216_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.40	40						92.22	38												42						40					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	216	0		29	10	S5660_216_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												
S5660	217	0		29	10	S5660_217_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	2	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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	2	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											154.48	50		50				140.59	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5660	217	0		29	10	S5660_217_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											98.72	47						98.14	45												49						47					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	217	0		29	10	S5660_217_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												
S5660	218	0		29	10	S5660_218_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					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.51	21		21				30.22	18		18												18						18			21			21								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				30								30			30		31											43.93	34						38.59	32												36						34					34			34								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											36.09	21		21				30.57	18		18												18						18			21			21								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				30								30			30		31											46.46	36						40.86	34												38						36					36			36								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											36.77	21		21				31.54	18		18												18						18			21			21								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				30								30			30		31											44.53	35						40.27	33												37						35					35			35								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.67	21		21				30.30	18		18												18						18			21			21								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				30								30			30		31											43.88	35						39.04	33												37						35					35			35								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.83	21		21				30.57	18		18												18						18			21			21								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				30								30			30		31											43.32	35						38.97	33												37						35					35			35								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.70	21		21				30.35	18		18												18						18			21			21								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				30								30			30		31											45.21	36						40.19	34												38						36					36			36								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.03	21		21				29.59	18		18												18						18			21			21								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				30								30			30		31											43.80	34						38.05	32												36						34					34			34								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											36.31	21		21				30.93	18		18												18						18			21			21								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				30								30			30		31											47.37	35						41.30	33												37						35					35			35								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.53	21		21				30.17	18		18												18						18			21			21								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				30								30			30		31											44.70	34						38.95	32												36						34					34			34								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											36.07	21		21				30.58	18		18												18						18			21			21								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				30								30			30		31											47.55	35						41.20	33												37						35					35			35								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.21	21		21				30.12	18		18												18						18			21			21								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				30								30			30		31											43.71	34						38.53	32												36						34					34			34								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.01	21		21				29.96	18		18												18						18			21			21								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				30								30			30		31											41.93	34						37.48	32												36						34					34			34								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											34.96	21		21				29.70	18		18												18						18			21			21								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				30								30			30		31											44.57	36						39.47	34												38						36					36			36								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											33.48	21		21				28.44	18		18												18						18			21			21								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				30								30			30		31											43.32	36						38.12	34												38						36					36			36								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											33.98	21		21				29.00	18		18												18						18			21			21								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				30								30			30		31											37.48	33						34.04	31												35						33					33			33								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				30								30			30		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	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	233	0		29	10	S5660_233_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	233	0		29	10	S5660_233_0	2	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											34.71	21		21				29.44	18		18												18						18			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	233	0		29	10	S5660_233_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											43.48	34						37.91	32												36						34					34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	233	0		29	10	S5660_233_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												
S5660	234	0		29	10	S5660_234_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					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											34.35	21		21				29.12	18		18												18						18			21			21								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				30								30			30		31											41.20	33						35.94	31												35						33					33			33								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											34.45	21		21				29.02	18		18												18						18			21			21								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				30								30			30		31											42.90	33						36.74	31												35						33					33			33								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											34.65	21		21				29.37	18		18												18						18			21			21								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				30								30			30		31											43.17	33						37.29	31												35						33					33			33								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.23	21		21				30.07	18		18												18						18			21			21								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				30								30			30		31											44.56	34						38.94	32												36						34					34			34								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.39	21		21				29.95	18		18												18						18			21			21								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				30								30			30		31											44.38	35						39.01	33												37						35					35			35								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											34.39	21		21				29.34	18		18												18						18			21			21								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				30								30			30		31											40.16	34						36.14	32												36						34					34			34								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											32.81	21		21				27.73	18		18												18						18			21			21								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				30								30			30		31											38.60	34						34.31	32												36						34					34			34								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											33.86	21		21				28.67	18		18												18						18			18			18								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				30								30			30		31											37.45	32						32.79	30												34						32					32			32								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											37.45	21		21				31.44	18		18												18						18			21			21								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				30								30			30		31											48.76	33						41.35	31												35						33					33			33								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.79	21		21				30.29	18		18												18						18			21			21								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				30								30			30		31											44.98	35						39.51	33												37						35					35			35								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											34.85	21		21				29.65	18		18												18						18			21			21								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				30								30			30		31											41.68	36						38.07	34												38						36					36			36								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											34.43	21		21				29.13	18		18												18						18			21			21								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				30								30			30		31											44.43	34						38.28	32												36						34					34			34								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.16	21		21				29.83	18		18												18						18			21			21								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				30								30			30		31											40.72	33						35.91	31												35						33					33			33								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											33.71	21		21				28.75	18		18												18						18			21			21								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				30								30			30		31											38.51	34						34.99	32												36						34					34			34								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.82	21		21				30.32	18		18												18						18			21			21								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				30								30			30		31											44.01	34						38.57	32												36						34					34			34								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											36.54	21		21				30.74	18		18												18						18			21			21								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				30								30			30		31											46.42	35						40.44	33												37						35					35			35								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.07	21		21				29.96	18		18												18						18			21			21								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				30								30			30		31											43.37	34						38.23	32												36						34					34			34								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				30								30			30		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	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											35.97	21		21				30.83	18		18												18						18			21			21								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				30								30			30		31											41.08	36						38.80	34												38						36					36			36								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				30								30			30		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	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				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	4	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					8.00		24.00													42.00						24.00				14.00				14.00			0.47	0.27				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_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					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	4	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											58.99	50		50				45.62	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_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						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	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				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	4	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	4	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	4	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											45.46	45		45				35.33	35		35												45						35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	4	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	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				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	4	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					8.00		24.00													42.00						24.00				14.00				14.00			0.47	0.27				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_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													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	4	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											53.07	50		50				41.50	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_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						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	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				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	4	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	4	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	4	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											34.34	45		45				26.81	35		35												45						35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	4	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	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				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	4	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					8.00		24.00													42.00						24.00				14.00				14.00			0.47	0.27				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_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					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	4	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											62.84	50		50				48.69	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_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						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	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				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	4	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	4	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	4	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											46.52	45		45				36.41	35		35												45						35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	4	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	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				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	4	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					8.00		24.00													42.00						24.00				14.00				14.00			0.47	0.27				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_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					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	4	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											52.71	50		50				41.18	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_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						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	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				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	4	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	4	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	4	Non-Preferred Brand	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											39.84	45		45				31.08	35		35												45						35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	4	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	3	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						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	3	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												
S5715	012	0		29	10	S5715_012_0	3	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											30.55	21		21				24.21	16		16												21						16			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											49.15	38		38				40.88	33		33												38						33			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	3	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	3	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						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	3	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												
S5715	013	0		29	10	S5715_013_0	3	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											28.62	19		19				21.43	14		14												19						14			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											54.58	34		34				43.31	29		29												34						29			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	3	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	3	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						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	3	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												
S5715	014	0		29	10	S5715_014_0	3	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.50	19		19				20.32	14		14												19						14			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											46.68	35		35				38.28	30		30												35						30			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	3	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	3	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						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	3	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												
S5715	015	0		29	10	S5715_015_0	3	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											30.58	21		21				23.47	16		16												21						16			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											44.36	39		39				38.29	34		34												39						34			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	3	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	3	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					1.00	2.00	3.00					1.00	2.00	3.00																13.00				13.00			0.43	0.03	0.03			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	013	0		29	10	S5726_013_0	3	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	10.00	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												
S5726	013	0		29	10	S5726_013_0	3	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								40.00	80.00	120.00					30.00	60.00	90.00					30.00	60.00	90.00																40.00				40.00			1.33	1.00	1.00			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	013	0		29	10	S5726_013_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											65.70	50	50	50				52.56	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	3	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	3	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	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	2.00	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	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	2.00	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	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	6.00	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	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	80.00	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	1	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											54.91	47	47	47				45.56	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	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												
S5726	014	0		29	10	S5726_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												
S5726	014	0		29	10	S5726_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		
S5743	001	0		29	10	S5743_001_0	3	Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					3.00	6.00	6.00											15.00	30.00	30.00				3.00	6.00	6.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	3	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	40.00					7.00	14.00	14.00											20.00	40.00	40.00				7.00	14.00	14.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	3	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											34.52	25	25	25				20.28	16	16	16										25	25	25				16	16	16			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.26	48	48	48				66.00	35	35	35										48	48	48				35	35	35			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_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												
S5743	004	0		29	10	S5743_004_0	2	Preferred Generic	4	11	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	11	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	11	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	11	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											24.67	25	25	25				18.12	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											76.19	50	50	50				74.48	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	3	Preferred Generic	2	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	12.50				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												
S5753	006	0		29	10	S5753_006_0	3	Generic	2	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								18.00	36.00	54.00					13.00	26.00	39.00											18.00	36.00	45.00				13.00	26.00	32.50					18.00			13.00			0.60	0.43		0.60	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	3	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					47.00			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	3	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											62.61	50	50	50				56.35	45	45	45										50	50	50				45	45	45				50		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	3	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	4	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	12.50				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												
S5753	007	0		29	10	S5753_007_0	4	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	12.50				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		
S5753	007	0		29	10	S5753_007_0	4	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								16.00	32.00	48.00					11.00	22.00	33.00											16.00	32.00	40.00				11.00	22.00	27.50					16.00			11.00			0.53	0.37		0.53	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	4	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								16.00	32.00	48.00					11.00	22.00	33.00											16.00	32.00	40.00				11.00	22.00	27.50					16.00			11.00			0.53	0.37		0.53	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5753	007	0		29	10	S5753_007_0	4	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					47.00			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	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											66.11	50	50	50				59.49	45	45	45										50	50	50				45	45	45				50		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	4	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	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	125	0		29	10	S5768_125_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	125	0		29	10	S5768_125_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	125	0		29	10	S5768_125_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	125	0		29	10	S5768_125_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	125	0		29	10	S5768_125_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											97.36	50	50	50				70.38	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	125	0		29	10	S5768_125_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	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											98.63	47	47	47				72.11	47	47	47										47	47	47				47	47	47				47		47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											98.14	48	48	48				68.08	48	48	48										48	48	48				48	48	48				48		48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											99.91	47	47	47				66.47	47	47	47										47	47	47				47	47	47				47		47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											99.33	50	50	50				67.06	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	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											99.58	49	49	49				66.57	49	49	49										49	49	49				49	49	49				49		49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											99.86	47	47	47				64.84	47	47	47										47	47	47				47	47	47				47		47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											99.05	47	47	47				64.54	47	47	47										47	47	47				47	47	47				47		47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											98.73	49	49	49				67.76	49	49	49										49	49	49				49	49	49				49		49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											98.78	47	47	47				67.33	47	47	47										47	47	47				47	47	47				47		47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											97.97	45	45	45				65.10	45	45	45										45	45	45				45	45	45				45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	136	0		29	10	S5768_136_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	136	0		29	10	S5768_136_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	136	0		29	10	S5768_136_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	136	0		29	10	S5768_136_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	136	0		29	10	S5768_136_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											99.28	45	45	45				64.95	45	45	45										45	45	45				45	45	45				45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	136	0		29	10	S5768_136_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	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											98.33	47	47	47				64.11	47	47	47										47	47	47				47	47	47				47		47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											97.86	46	46	46				63.90	46	46	46										46	46	46				46	46	46				46		46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											92.81	45	45	45				62.89	45	45	45										45	45	45				45	45	45				45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											99.07	47	47	47				64.84	47	47	47										47	47	47				47	47	47				47		47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	2	Preferred Generic	4	01	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	141	0		29	10	S5768_141_0	2	Preferred Generic	4	01	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	141	0		29	10	S5768_141_0	2	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	141	0		29	10	S5768_141_0	2	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	141	0		29	10	S5768_141_0	2	Preferred Brand	4	11	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	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.73	50	50	50				70.69	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	2	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	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	142	0		29	10	S5768_142_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	142	0		29	10	S5768_142_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	142	0		29	10	S5768_142_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	142	0		29	10	S5768_142_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	142	0		29	10	S5768_142_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											98.67	46	46	46				66.68	46	46	46										46	46	46				46	46	46				46		46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	142	0		29	10	S5768_142_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	143	0		29	10	S5768_143_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	143	0		29	10	S5768_143_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	143	0		29	10	S5768_143_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	143	0		29	10	S5768_143_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	143	0		29	10	S5768_143_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	143	0		29	10	S5768_143_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											98.03	49	49	49				65.99	49	49	49										49	49	49				49	49	49				49		49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	143	0		29	10	S5768_143_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	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											92.09	49	49	49				62.29	49	49	49										49	49	49				49	49	49				49		49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											97.86	46	46	46				65.31	46	46	46										46	46	46				46	46	46				46		46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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	146	0		29	10	S5768_146_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	146	0		29	10	S5768_146_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	146	0		29	10	S5768_146_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	146	0		29	10	S5768_146_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	146	0		29	10	S5768_146_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											86.75	48	48	48				53.54	48	48	48										48	48	48				48	48	48				48		48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	146	0		29	10	S5768_146_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	147	0		29	10	S5768_147_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	147	0		29	10	S5768_147_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	147	0		29	10	S5768_147_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	147	0		29	10	S5768_147_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	147	0		29	10	S5768_147_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	147	0		29	10	S5768_147_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											99.46	50	50	50				74.74	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	147	0		29	10	S5768_147_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	148	0		29	10	S5768_148_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	148	0		29	10	S5768_148_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	148	0		29	10	S5768_148_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	148	0		29	10	S5768_148_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	148	0		29	10	S5768_148_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	148	0		29	10	S5768_148_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											97.97	50	50	50				71.58	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	148	0		29	10	S5768_148_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	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					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	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					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	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					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	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					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	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											98.02	44	44	44				64.35	44	44	44										44	44	44				44	44	44				44		44								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					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	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					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	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					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	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					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	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											99.71	45	45	45				73.15	45	45	45										45	45	45				45	45	45				45		45								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											99.85	48	48	48				70.12	48	48	48										48	48	48				48	48	48				48		48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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					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	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					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	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					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	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					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	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											99.09	42	42	42				71.79	42	42	42										42	42	42				42	42	42				42		42								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	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	153	0		29	10	S5768_153_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	153	0		29	10	S5768_153_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	153	0		29	10	S5768_153_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	153	0		29	10	S5768_153_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	153	0		29	10	S5768_153_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											98.87	48	48	48				71.09	48	48	48										48	48	48				48	48	48				48		48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	153	0		29	10	S5768_153_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	154	0		29	10	S5768_154_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	154	0		29	10	S5768_154_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	154	0		29	10	S5768_154_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	154	0		29	10	S5768_154_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	154	0		29	10	S5768_154_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	154	0		29	10	S5768_154_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											99.49	49	49	49				73.64	49	49	49										49	49	49				49	49	49				49		49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	154	0		29	10	S5768_154_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	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											97.97	48	48	48				68.05	48	48	48										48	48	48				48	48	48				48		48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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					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	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					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	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					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	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					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	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											98.87	48	48	48				72.75	48	48	48										48	48	48				48	48	48				48		48								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	2	Preferred Generic	4	01	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	198	0		29	10	S5768_198_0	2	Preferred Generic	4	01	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	198	0		29	10	S5768_198_0	2	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	198	0		29	10	S5768_198_0	2	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	198	0		29	10	S5768_198_0	2	Preferred Brand	4	11	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	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.09	47	47	47				78.35	47	47	47										47	47	47				47	47	47				47		47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	2	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											98.72	43	43	43				68.27	43	43	43										43	43	43				43	43	43				43		43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	3	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	3	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	3	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	3	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	3	Preferred Brand	4	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	002	0		29	10	S5795_002_0	3	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	3	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	3	Preferred Generic	3	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 Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	3	Generic	3	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		37.50					5.00		12.50					5.00		12.50																15.00				5.00			0.50	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	003	0		29	10	S5795_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		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 Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											37.39	50		50				32.37	45		45				45		45															50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	3	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 Drug, 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	2	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												
S5805	001	0		29	10	S5805_001_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											94.00	45		45				72.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1016.00	33		33				1016.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											71.56	35	35	35				61.26	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											76.97	35	35	35				64.00	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	27						1.00	27												27						27						27		27								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											78.68	35	35	35				61.71	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	28						1.00	28												28						28						28		28								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											74.38	35	35	35				56.82	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	27						1.00	27												27						27						27		27								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											79.06	35	35	35				67.33	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	27						1.00	27												27						27						27		27								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											73.79	35	35	35				58.53	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	27						1.00	27												27						27						27		27								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											76.40	35	35	35				62.70	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	27						1.00	27												27						27						27		27								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											77.70	35	35	35				62.16	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											77.90	35	35	35				59.60	35	35	35										35	35	35				35	35	35				35		35								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	26						1.00	26												26						26						26		26								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											73.14	35	35	35				56.00	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											74.49	35	35	35				50.56	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	26						1.00	26												26						26						26		26								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											74.04	35	35	35				58.87	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	27						1.00	27												27						27						27		27								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											75.03	35	35	35				62.95	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	29						1.00	29												29						29						29		29								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											74.22	35	35	35				59.21	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											79.37	35	35	35				64.61	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											71.45	35	35	35				59.37	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	29						1.00	29												29						29						29		29								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											73.76	35	35	35				55.78	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											70.23	35	35	35				56.28	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	27						1.00	27												27						27						27		27								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											74.83	35	35	35				54.84	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	26						1.00	26												26						26						26		26								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											76.92	35	35	35				54.54	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	27						1.00	27												27						27						27		27								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											70.20	35	35	35				56.64	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	28						1.00	28												28						28						28		28								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											80.03	35	35	35				58.21	35	35	35										35	35	35				35	35	35				35		35								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	26						1.00	26												26						26						26		26								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											74.99	35	35	35				58.58	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											70.29	35	35	35				54.13	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											70.95	35	35	35				56.97	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											78.35	35	35	35				56.54	35	35	35										35	35	35				35	35	35				35		35								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	25						1.00	25												25						25						25		25								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											77.83	35	35	35				58.18	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											81.09	35	35	35				58.93	35	35	35										35	35	35				35	35	35				35		35								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	25						1.00	25												25						25						25		25								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											85.46	35	35	35				63.70	35	35	35										35	35	35				35	35	35				35		35								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	25						1.00	25												25						25						25		25								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											72.17	35	35	35				60.03	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											76.26	35	35	35				56.50	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											77.93	35	35	35				61.05	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	27						1.00	27												27						27						27		27								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											99.58	38	38	38				84.03	38	38	38										38	38	38				38	38	38				38		38								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								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	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											71.85	35	35	35				59.19	35	35	35										35	35	35				35	35	35				35		35								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	2	Preferred Generic	4	01	1	2	1	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												
S5810	276	0		29	10	S5810_276_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	276	0		29	10	S5810_276_0	2	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												
S5810	276	0		29	10	S5810_276_0	2	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		
S5810	276	0		29	10	S5810_276_0	2	Preferred Brand	4	11	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												
S5810	276	0		29	10	S5810_276_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.38	40	40	40				73.72	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	276	0		29	10	S5810_276_0	2	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												
S5810	277	0		29	10	S5810_277_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	277	0		29	10	S5810_277_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	277	0		29	10	S5810_277_0	2	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												
S5810	277	0		29	10	S5810_277_0	2	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		
S5810	277	0		29	10	S5810_277_0	2	Preferred Brand	4	11	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												
S5810	277	0		29	10	S5810_277_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.74	40	40	40				73.88	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	277	0		29	10	S5810_277_0	2	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												
S5810	278	0		29	10	S5810_278_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	278	0		29	10	S5810_278_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	278	0		29	10	S5810_278_0	2	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												
S5810	278	0		29	10	S5810_278_0	2	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		
S5810	278	0		29	10	S5810_278_0	2	Preferred Brand	4	11	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												
S5810	278	0		29	10	S5810_278_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.90	40	40	40				73.09	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	278	0		29	10	S5810_278_0	2	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												
S5810	279	0		29	10	S5810_279_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	279	0		29	10	S5810_279_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	279	0		29	10	S5810_279_0	2	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												
S5810	279	0		29	10	S5810_279_0	2	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		
S5810	279	0		29	10	S5810_279_0	2	Preferred Brand	4	11	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												
S5810	279	0		29	10	S5810_279_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.15	40	40	40				73.12	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	279	0		29	10	S5810_279_0	2	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												
S5810	280	0		29	10	S5810_280_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	280	0		29	10	S5810_280_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	280	0		29	10	S5810_280_0	2	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												
S5810	280	0		29	10	S5810_280_0	2	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		
S5810	280	0		29	10	S5810_280_0	2	Preferred Brand	4	11	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												
S5810	280	0		29	10	S5810_280_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.44	40	40	40				72.76	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	280	0		29	10	S5810_280_0	2	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												
S5810	281	0		29	10	S5810_281_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	281	0		29	10	S5810_281_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	281	0		29	10	S5810_281_0	2	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												
S5810	281	0		29	10	S5810_281_0	2	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		
S5810	281	0		29	10	S5810_281_0	2	Preferred Brand	4	11	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												
S5810	281	0		29	10	S5810_281_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.26	40	40	40				71.78	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	281	0		29	10	S5810_281_0	2	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												
S5810	282	0		29	10	S5810_282_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	282	0		29	10	S5810_282_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	282	0		29	10	S5810_282_0	2	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												
S5810	282	0		29	10	S5810_282_0	2	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		
S5810	282	0		29	10	S5810_282_0	2	Preferred Brand	4	11	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												
S5810	282	0		29	10	S5810_282_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											91.52	40	40	40				71.03	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	282	0		29	10	S5810_282_0	2	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												
S5810	283	0		29	10	S5810_283_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	283	0		29	10	S5810_283_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	283	0		29	10	S5810_283_0	2	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												
S5810	283	0		29	10	S5810_283_0	2	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		
S5810	283	0		29	10	S5810_283_0	2	Preferred Brand	4	11	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												
S5810	283	0		29	10	S5810_283_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.99	40	40	40				75.41	40	40	40										40	40	40				40	40	40				40		40								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		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	284	0		29	10	S5810_284_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	284	0		29	10	S5810_284_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	284	0		29	10	S5810_284_0	2	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												
S5810	284	0		29	10	S5810_284_0	2	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		
S5810	284	0		29	10	S5810_284_0	2	Preferred Brand	4	11	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												
S5810	284	0		29	10	S5810_284_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											91.83	40	40	40				73.92	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	284	0		29	10	S5810_284_0	2	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												
S5810	285	0		29	10	S5810_285_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	285	0		29	10	S5810_285_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	285	0		29	10	S5810_285_0	2	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												
S5810	285	0		29	10	S5810_285_0	2	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		
S5810	285	0		29	10	S5810_285_0	2	Preferred Brand	4	11	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												
S5810	285	0		29	10	S5810_285_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											91.63	40	40	40				72.74	40	40	40										40	40	40				40	40	40				40		40								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		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	286	0		29	10	S5810_286_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	286	0		29	10	S5810_286_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	286	0		29	10	S5810_286_0	2	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												
S5810	286	0		29	10	S5810_286_0	2	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		
S5810	286	0		29	10	S5810_286_0	2	Preferred Brand	4	11	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												
S5810	286	0		29	10	S5810_286_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.91	40	40	40				72.18	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	286	0		29	10	S5810_286_0	2	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												
S5810	287	0		29	10	S5810_287_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	287	0		29	10	S5810_287_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	287	0		29	10	S5810_287_0	2	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												
S5810	287	0		29	10	S5810_287_0	2	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		
S5810	287	0		29	10	S5810_287_0	2	Preferred Brand	4	11	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												
S5810	287	0		29	10	S5810_287_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											87.50	40	40	40				69.96	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	287	0		29	10	S5810_287_0	2	Specialty Tier	4	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	288	0		29	10	S5810_288_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	288	0		29	10	S5810_288_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	288	0		29	10	S5810_288_0	2	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												
S5810	288	0		29	10	S5810_288_0	2	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		
S5810	288	0		29	10	S5810_288_0	2	Preferred Brand	4	11	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												
S5810	288	0		29	10	S5810_288_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.40	40	40	40				70.91	40	40	40										40	40	40				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		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	289	0		29	10	S5810_289_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	289	0		29	10	S5810_289_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	289	0		29	10	S5810_289_0	2	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												
S5810	289	0		29	10	S5810_289_0	2	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		
S5810	289	0		29	10	S5810_289_0	2	Preferred Brand	4	11	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												
S5810	289	0		29	10	S5810_289_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											86.92	40	40	40				66.61	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	289	0		29	10	S5810_289_0	2	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												
S5810	290	0		29	10	S5810_290_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	290	0		29	10	S5810_290_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	290	0		29	10	S5810_290_0	2	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												
S5810	290	0		29	10	S5810_290_0	2	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		
S5810	290	0		29	10	S5810_290_0	2	Preferred Brand	4	11	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												
S5810	290	0		29	10	S5810_290_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.02	40	40	40				65.99	40	40	40										40	40	40				40	40	40				40		40								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		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	291	0		29	10	S5810_291_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	291	0		29	10	S5810_291_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	291	0		29	10	S5810_291_0	2	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												
S5810	291	0		29	10	S5810_291_0	2	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		
S5810	291	0		29	10	S5810_291_0	2	Preferred Brand	4	11	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												
S5810	291	0		29	10	S5810_291_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											90.10	40	40	40				68.71	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	291	0		29	10	S5810_291_0	2	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												
S5810	292	0		29	10	S5810_292_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	292	0		29	10	S5810_292_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	292	0		29	10	S5810_292_0	2	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												
S5810	292	0		29	10	S5810_292_0	2	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		
S5810	292	0		29	10	S5810_292_0	2	Preferred Brand	4	11	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												
S5810	292	0		29	10	S5810_292_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											87.60	40	40	40				72.84	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	292	0		29	10	S5810_292_0	2	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												
S5810	293	0		29	10	S5810_293_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	293	0		29	10	S5810_293_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	293	0		29	10	S5810_293_0	2	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												
S5810	293	0		29	10	S5810_293_0	2	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		
S5810	293	0		29	10	S5810_293_0	2	Preferred Brand	4	11	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												
S5810	293	0		29	10	S5810_293_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											91.91	40	40	40				71.27	40	40	40										40	40	40				40	40	40				40		40								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		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	294	0		29	10	S5810_294_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	294	0		29	10	S5810_294_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	294	0		29	10	S5810_294_0	2	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												
S5810	294	0		29	10	S5810_294_0	2	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		
S5810	294	0		29	10	S5810_294_0	2	Preferred Brand	4	11	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												
S5810	294	0		29	10	S5810_294_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.71	40	40	40				68.11	40	40	40										40	40	40				40	40	40				40		40								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		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	295	0		29	10	S5810_295_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	295	0		29	10	S5810_295_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	295	0		29	10	S5810_295_0	2	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												
S5810	295	0		29	10	S5810_295_0	2	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		
S5810	295	0		29	10	S5810_295_0	2	Preferred Brand	4	11	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												
S5810	295	0		29	10	S5810_295_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											92.31	40	40	40				72.15	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	295	0		29	10	S5810_295_0	2	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												
S5810	296	0		29	10	S5810_296_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	296	0		29	10	S5810_296_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	296	0		29	10	S5810_296_0	2	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												
S5810	296	0		29	10	S5810_296_0	2	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		
S5810	296	0		29	10	S5810_296_0	2	Preferred Brand	4	11	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												
S5810	296	0		29	10	S5810_296_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											90.23	40	40	40				71.22	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	296	0		29	10	S5810_296_0	2	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												
S5810	297	0		29	10	S5810_297_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	297	0		29	10	S5810_297_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	297	0		29	10	S5810_297_0	2	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												
S5810	297	0		29	10	S5810_297_0	2	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		
S5810	297	0		29	10	S5810_297_0	2	Preferred Brand	4	11	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												
S5810	297	0		29	10	S5810_297_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.93	40	40	40				68.95	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	297	0		29	10	S5810_297_0	2	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												
S5810	298	0		29	10	S5810_298_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	298	0		29	10	S5810_298_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	298	0		29	10	S5810_298_0	2	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												
S5810	298	0		29	10	S5810_298_0	2	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		
S5810	298	0		29	10	S5810_298_0	2	Preferred Brand	4	11	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												
S5810	298	0		29	10	S5810_298_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.12	40	40	40				68.42	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	298	0		29	10	S5810_298_0	2	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												
S5810	299	0		29	10	S5810_299_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	299	0		29	10	S5810_299_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	299	0		29	10	S5810_299_0	2	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												
S5810	299	0		29	10	S5810_299_0	2	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		
S5810	299	0		29	10	S5810_299_0	2	Preferred Brand	4	11	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												
S5810	299	0		29	10	S5810_299_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.12	40	40	40				69.42	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	299	0		29	10	S5810_299_0	2	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												
S5810	300	0		29	10	S5810_300_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	300	0		29	10	S5810_300_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	300	0		29	10	S5810_300_0	2	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												
S5810	300	0		29	10	S5810_300_0	2	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		
S5810	300	0		29	10	S5810_300_0	2	Preferred Brand	4	11	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												
S5810	300	0		29	10	S5810_300_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.58	40	40	40				69.14	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	300	0		29	10	S5810_300_0	2	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												
S5810	301	0		29	10	S5810_301_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	301	0		29	10	S5810_301_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	301	0		29	10	S5810_301_0	2	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												
S5810	301	0		29	10	S5810_301_0	2	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		
S5810	301	0		29	10	S5810_301_0	2	Preferred Brand	4	11	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												
S5810	301	0		29	10	S5810_301_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											87.65	40	40	40				66.09	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	301	0		29	10	S5810_301_0	2	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												
S5810	302	0		29	10	S5810_302_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	302	0		29	10	S5810_302_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	302	0		29	10	S5810_302_0	2	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												
S5810	302	0		29	10	S5810_302_0	2	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		
S5810	302	0		29	10	S5810_302_0	2	Preferred Brand	4	11	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												
S5810	302	0		29	10	S5810_302_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.91	40	40	40				68.58	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	302	0		29	10	S5810_302_0	2	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												
S5810	303	0		29	10	S5810_303_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	303	0		29	10	S5810_303_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	303	0		29	10	S5810_303_0	2	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												
S5810	303	0		29	10	S5810_303_0	2	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		
S5810	303	0		29	10	S5810_303_0	2	Preferred Brand	4	11	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												
S5810	303	0		29	10	S5810_303_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.85	40	40	40				73.23	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	303	0		29	10	S5810_303_0	2	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												
S5810	304	0		29	10	S5810_304_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	304	0		29	10	S5810_304_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	304	0		29	10	S5810_304_0	2	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												
S5810	304	0		29	10	S5810_304_0	2	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		
S5810	304	0		29	10	S5810_304_0	2	Preferred Brand	4	11	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												
S5810	304	0		29	10	S5810_304_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.03	40	40	40				71.84	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	304	0		29	10	S5810_304_0	2	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												
S5810	305	0		29	10	S5810_305_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	305	0		29	10	S5810_305_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	305	0		29	10	S5810_305_0	2	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												
S5810	305	0		29	10	S5810_305_0	2	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		
S5810	305	0		29	10	S5810_305_0	2	Preferred Brand	4	11	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												
S5810	305	0		29	10	S5810_305_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											87.73	40	40	40				68.21	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	305	0		29	10	S5810_305_0	2	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												
S5810	306	0		29	10	S5810_306_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	306	0		29	10	S5810_306_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	306	0		29	10	S5810_306_0	2	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												
S5810	306	0		29	10	S5810_306_0	2	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		
S5810	306	0		29	10	S5810_306_0	2	Preferred Brand	4	11	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												
S5810	306	0		29	10	S5810_306_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											91.14	40	40	40				70.73	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	306	0		29	10	S5810_306_0	2	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												
S5810	307	0		29	10	S5810_307_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	307	0		29	10	S5810_307_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	307	0		29	10	S5810_307_0	2	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												
S5810	307	0		29	10	S5810_307_0	2	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		
S5810	307	0		29	10	S5810_307_0	2	Preferred Brand	4	11	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												
S5810	307	0		29	10	S5810_307_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.03	40	40	40				68.40	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	307	0		29	10	S5810_307_0	2	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												
S5810	308	0		29	10	S5810_308_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	308	0		29	10	S5810_308_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	308	0		29	10	S5810_308_0	2	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												
S5810	308	0		29	10	S5810_308_0	2	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		
S5810	308	0		29	10	S5810_308_0	2	Preferred Brand	4	11	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												
S5810	308	0		29	10	S5810_308_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											95.25	40	40	40				72.50	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	308	0		29	10	S5810_308_0	2	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												
S5810	309	0		29	10	S5810_309_0	2	Preferred Generic	4	01	1	2	1	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												
S5810	309	0		29	10	S5810_309_0	2	Preferred Generic	4	01	1	2	1	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		
S5810	309	0		29	10	S5810_309_0	2	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												
S5810	309	0		29	10	S5810_309_0	2	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		
S5810	309	0		29	10	S5810_309_0	2	Preferred Brand	4	11	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												
S5810	309	0		29	10	S5810_309_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.42	40	40	40				70.23	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	309	0		29	10	S5810_309_0	2	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												
S5820	001	0		29	10	S5820_001_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	001	0		29	10	S5820_001_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											82.00	45		45				66.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	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	002	0		29	10	S5820_002_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	002	0		29	10	S5820_002_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				67.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1040.00	33		33				1040.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	003	0		29	10	S5820_003_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											88.00	45		45				68.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1026.00	33		33				1026.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	004	0		29	10	S5820_004_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											89.00	45		45				67.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											965.00	33		33				965.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	005	0		29	10	S5820_005_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											82.00	45		45				63.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1166.00	33		33				1166.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	006	0		29	10	S5820_006_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											81.00	45		45				63.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	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	007	0		29	10	S5820_007_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	007	0		29	10	S5820_007_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											89.00	45		45				65.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1192.00	33		33				1192.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	008	0		29	10	S5820_008_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											81.00	45		45				55.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1271.00	33		33				1271.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	009	0		29	10	S5820_009_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											86.00	45		45				64.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1153.00	33		33				1153.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	010	0		29	10	S5820_010_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											90.00	45		45				64.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	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	011	0		29	10	S5820_011_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	011	0		29	10	S5820_011_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				63.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	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	012	0		29	10	S5820_012_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	012	0		29	10	S5820_012_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											82.00	45		45				64.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1075.00	33		33				1075.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	013	0		29	10	S5820_013_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											81.00	45		45				62.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1114.00	33		33				1114.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	014	0		29	10	S5820_014_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											84.00	45		45				64.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1125.00	33		33				1125.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	015	0		29	10	S5820_015_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											91.00	45		45				68.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1125.00	33		33				1125.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	016	0		29	10	S5820_016_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											87.00	45		45				66.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1029.00	33		33				1029.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	017	0		29	10	S5820_017_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											82.00	45		45				63.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1020.00	33		33				1020.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	018	0		29	10	S5820_018_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											86.00	45		45				60.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											911.00	33		33				911.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	019	0		29	10	S5820_019_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											82.00	45		45				62.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1236.00	33		33				1236.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	020	0		29	10	S5820_020_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											84.00	45		45				68.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1016.00	33		33				1016.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	021	0		29	10	S5820_021_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				65.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1087.00	33		33				1087.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	022	0		29	10	S5820_022_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				59.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1237.00	33		33				1237.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	023	0		29	10	S5820_023_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				64.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											958.00	33		33				958.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	024	0		29	10	S5820_024_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				67.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1072.00	33		33				1072.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	025	0		29	10	S5820_025_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											84.00	45		45				65.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1339.00	33		33				1339.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	026	0		29	10	S5820_026_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											88.00	45		45				67.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	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	027	0		29	10	S5820_027_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	027	0		29	10	S5820_027_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											84.00	45		45				64.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1283.00	33		33				1283.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	028	0		29	10	S5820_028_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											93.00	45		45				70.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	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	029	0		29	10	S5820_029_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	029	0		29	10	S5820_029_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											76.00	45		45				61.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1150.00	33		33				1150.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	030	0		29	10	S5820_030_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				55.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1283.00	33		33				1283.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	031	0		29	10	S5820_031_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											91.00	45		45				71.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											994.00	33		33				994.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	032	0		29	10	S5820_032_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				71.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											833.00	33		33				833.00	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	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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												
S5820	033	0		29	10	S5820_033_0	1	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	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	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						105.00				47.00				47.00			1.56	1.33				1.51	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	1		110	01		100	1				30		90	2	2						90	30		31											83.00	45		45				75.00	40		40												45						40			45			45								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	1		110	01		100	1				30		90	2	2						90	30		31											1130.00	33		33				1130.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	1	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.09	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				2	2			90				30		31	11.00		33.00																					33.00																11.00				11.00		0.36						0.35	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				2	2			90				30		31	25.00		75.00																					75.00																25.00				25.00		0.83						0.80	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				2	2			90				30		31				89.00	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				2	2			90				30		31				1171.00	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				2	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				2	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				2	2			90				30		31	26.00		78.00																					78.00																26.00				26.00		0.86						0.83	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				2	2			90				30		31				67.00	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				2	2			90				30		31				876.00	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				2	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				2	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 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				2	2			90				30		31	25.00		75.00																					75.00																25.00				25.00		0.83						0.80	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				2	2			90				30		31				72.00	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				2	2			90				30		31				951.00	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	2	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	2	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	2	2						90	30		31								32.00		96.00					27.00		81.00													96.00						81.00				32.00				32.00			1.06	0.90				1.03	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	2	2						90	30		31											68.00	50		50				48.00	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	2	2						90	30		31											1510.00	25		25				1510.00	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				2	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				2	2			90				30		31	19.00		57.00																					57.00																19.00				19.00		0.63						0.61	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				2	2			90				30		31	25.00		75.00																					75.00																25.00				25.00		0.83						0.80	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				2	2			90				30		31				104.00	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				2	2			90				30		31				896.00	25		25																				25															25			25								Preferred Generic, 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	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												
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	10.00		30.00																									10.00		30.00				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												
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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				55.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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	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												
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	10.00		30.00																									10.00		30.00				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												
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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				68.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	5	Preferred Generic	4	11	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												
S5884	004	0		29	10	S5884_004_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	004	0		29	10	S5884_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	5	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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	004	0		29	10	S5884_004_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												
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	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												
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	10.00		30.00																									10.00		30.00				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												
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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				65.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	008	0		29	10	S5884_008_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																									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												
S5884	008	0		29	10	S5884_008_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	008	0		29	10	S5884_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				61.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	008	0		29	10	S5884_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												
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	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												
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	10.00		30.00																									10.00		30.00				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												
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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				59.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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	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												
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	10.00		30.00																									10.00		30.00				10.00		7.00				10.00				10.00		0.33				0.33	0.33	0.32	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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				73.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	015	0		29	10	S5884_015_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																									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												
S5884	015	0		29	10	S5884_015_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	015	0		29	10	S5884_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	3	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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	015	0		29	10	S5884_015_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												
S5884	019	0		29	10	S5884_019_0	4	Preferred Generic	4	11	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												
S5884	019	0		29	10	S5884_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	019	0		29	10	S5884_019_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	019	0		29	10	S5884_019_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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	019	0		29	10	S5884_019_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												
S5884	020	0		29	10	S5884_020_0	4	Preferred Generic	4	11	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												
S5884	020	0		29	10	S5884_020_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	020	0		29	10	S5884_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	020	0		29	10	S5884_020_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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	020	0		29	10	S5884_020_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												
S5884	021	0		29	10	S5884_021_0	4	Preferred Generic	4	11	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												
S5884	021	0		29	10	S5884_021_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	021	0		29	10	S5884_021_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	021	0		29	10	S5884_021_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		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	021	0		29	10	S5884_021_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												
S5884	022	0		29	10	S5884_022_0	4	Preferred Generic	4	11	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												
S5884	022	0		29	10	S5884_022_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	022	0		29	10	S5884_022_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	022	0		29	10	S5884_022_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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	022	0		29	10	S5884_022_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												
S5884	024	0		29	10	S5884_024_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																									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												
S5884	024	0		29	10	S5884_024_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	024	0		29	10	S5884_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				55.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	024	0		29	10	S5884_024_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												
S5884	028	0		29	10	S5884_028_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																									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												
S5884	028	0		29	10	S5884_028_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	028	0		29	10	S5884_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	3	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		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	028	0		29	10	S5884_028_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												
S5884	030	0		29	10	S5884_030_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																									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												
S5884	030	0		29	10	S5884_030_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	030	0		29	10	S5884_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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	030	0		29	10	S5884_030_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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	030	0		29	10	S5884_030_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												
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	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												
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	10.00		30.00																									10.00		30.00				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												
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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				73.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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	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												
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	10.00		30.00																									10.00		30.00				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												
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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				63.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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	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												
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	10.00		30.00																									10.00		30.00				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												
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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				61.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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	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												
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	10.00		30.00																									10.00		30.00				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												
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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				62.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	072	0		29	10	S5884_072_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																									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												
S5884	072	0		29	10	S5884_072_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	072	0		29	10	S5884_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	3	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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	072	0		29	10	S5884_072_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												
S5884	073	0		29	10	S5884_073_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																									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												
S5884	073	0		29	10	S5884_073_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	073	0		29	10	S5884_073_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	3	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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	073	0		29	10	S5884_073_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												
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	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												
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	10.00		30.00																									10.00		30.00				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												
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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				69.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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	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												
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	10.00		30.00																									10.00		30.00				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												
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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				62.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	4	Preferred Generic	4	11	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												
S5884	077	0		29	10	S5884_077_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	077	0		29	10	S5884_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				61.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	077	0		29	10	S5884_077_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												
S5884	078	0		29	10	S5884_078_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																									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												
S5884	078	0		29	10	S5884_078_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	078	0		29	10	S5884_078_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	3	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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	078	0		29	10	S5884_078_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												
S5884	083	0		29	10	S5884_083_0	4	Preferred Generic	4	11	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												
S5884	083	0		29	10	S5884_083_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	083	0		29	10	S5884_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				61.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	083	0		29	10	S5884_083_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												
S5884	085	0		29	10	S5884_085_0	4	Preferred Generic	4	11	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												
S5884	085	0		29	10	S5884_085_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	085	0		29	10	S5884_085_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	085	0		29	10	S5884_085_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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	085	0		29	10	S5884_085_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												
S5884	086	0		29	10	S5884_086_0	4	Preferred Generic	4	11	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												
S5884	086	0		29	10	S5884_086_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		7.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	086	0		29	10	S5884_086_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	086	0		29	10	S5884_086_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		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	086	0		29	10	S5884_086_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												
S5884	087	0		29	10	S5884_087_0	5	Preferred Generic	4	11	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												
S5884	087	0		29	10	S5884_087_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	087	0		29	10	S5884_087_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	5	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		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	087	0		29	10	S5884_087_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												
S5884	089	0		29	10	S5884_089_0	5	Preferred Generic	4	11	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												
S5884	089	0		29	10	S5884_089_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	089	0		29	10	S5884_089_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	5	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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	089	0		29	10	S5884_089_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												
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	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												
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	10.00		30.00																									10.00		30.00				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												
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																									47.00		141.00				47.00		116.00				47.00				47.00		1.57				1.57	1.57	1.52	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	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				62.00	50		50																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	5	Preferred Generic	4	11	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												
S5884	093	0		29	10	S5884_093_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	093	0		29	10	S5884_093_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	5	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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	093	0		29	10	S5884_093_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												
S5884	094	0		29	10	S5884_094_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																									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												
S5884	094	0		29	10	S5884_094_0	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	094	0		29	10	S5884_094_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		116.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	3	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																								50		50				50		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	094	0		29	10	S5884_094_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												
S5884	101	0		29	10	S5884_101_0	4	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	4	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	101	0		29	10	S5884_101_0	4	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				28.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	4	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				60.00	36		36																								36		36				36		30			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	4	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												
S5884	102	0		29	10	S5884_102_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	102	0		29	10	S5884_102_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				29.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				63.00	35		35																								35		35				35		30			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_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												
S5884	103	0		29	10	S5884_103_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	103	0		29	10	S5884_103_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				30.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	3	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																								37		37				37		30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_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												
S5884	104	0		29	10	S5884_104_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	104	0		29	10	S5884_104_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				28.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				67.00	38		38																								38		38				38		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_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												
S5884	105	0		29	10	S5884_105_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	105	0		29	10	S5884_105_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				26.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				70.00	42		42																								42		42				42		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_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												
S5884	106	0		29	10	S5884_106_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	106	0		29	10	S5884_106_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				25.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				63.00	38		38																								38		38				38		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_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												
S5884	107	0		29	10	S5884_107_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	107	0		29	10	S5884_107_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				29.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				68.00	40		40																								40		40				40		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_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												
S5884	108	0		29	10	S5884_108_0	4	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	4	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	108	0		29	10	S5884_108_0	4	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				27.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	4	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																								36		36				36		30			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	4	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												
S5884	109	0		29	10	S5884_109_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	109	0		29	10	S5884_109_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				24.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				58.00	40		40																								40		40				40		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_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												
S5884	110	0		29	10	S5884_110_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	110	0		29	10	S5884_110_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				30.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				67.00	40		40																								40		40				40		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_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												
S5884	111	0		29	10	S5884_111_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	111	0		29	10	S5884_111_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				28.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				64.00	35		35																								35		35				35		30			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_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												
S5884	112	0		29	10	S5884_112_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	112	0		29	10	S5884_112_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				27.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	3	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																								36		36				36		30			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_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												
S5884	113	0		29	10	S5884_113_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	113	0		29	10	S5884_113_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				27.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				65.00	39		39																								39		39				39		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_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												
S5884	114	0		29	10	S5884_114_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	114	0		29	10	S5884_114_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				32.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				70.00	34		34																								34		34				34		30			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_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												
S5884	115	0		29	10	S5884_115_0	2	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	2	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	115	0		29	10	S5884_115_0	2	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				27.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				65.00	47		47																								47		47				47		30			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_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												
S5884	116	0		29	10	S5884_116_0	4	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	4	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	116	0		29	10	S5884_116_0	4	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				31.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	4	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				56.00	34		34																								34		34				34		30			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	4	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												
S5884	131	0		29	10	S5884_131_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	131	0		29	10	S5884_131_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				30.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				68.00	35		35																								35		35				35		30			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_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												
S5884	132	0		29	10	S5884_132_0	4	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	4	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	132	0		29	10	S5884_132_0	4	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				29.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	4	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																								37		37				37		30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	4	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												
S5884	133	0		29	10	S5884_133_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	133	0		29	10	S5884_133_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				29.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	3	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																								37		37				37		30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_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												
S5884	134	0		29	10	S5884_134_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	134	0		29	10	S5884_134_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				25.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				71.00	49		49																								49		49				49		30			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_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												
S5884	135	0		29	10	S5884_135_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	135	0		29	10	S5884_135_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				26.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	3	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																								37		37				37		30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_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												
S5884	136	0		29	10	S5884_136_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	136	0		29	10	S5884_136_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				27.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	3	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																								36		36				36		30			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_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												
S5884	137	0		29	10	S5884_137_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	137	0		29	10	S5884_137_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				28.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				65.00	38		38																								38		38				38		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_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												
S5884	138	0		29	10	S5884_138_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	138	0		29	10	S5884_138_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				28.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				68.00	39		39																								39		39				39		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_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												
S5884	139	0		29	10	S5884_139_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	139	0		29	10	S5884_139_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				27.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				68.00	39		39																								39		39				39		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_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												
S5884	140	0		29	10	S5884_140_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	140	0		29	10	S5884_140_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				26.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				65.00	38		38																								38		38				38		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_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												
S5884	141	0		29	10	S5884_141_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	141	0		29	10	S5884_141_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				25.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				66.00	43		43																								43		43				43		30			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_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												
S5884	142	0		29	10	S5884_142_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	142	0		29	10	S5884_142_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				28.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				63.00	38		38																								38		38				38		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_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												
S5884	143	0		29	10	S5884_143_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	143	0		29	10	S5884_143_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				29.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				69.00	37		37																								37		37				37		30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_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												
S5884	144	0		29	10	S5884_144_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	144	0		29	10	S5884_144_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				27.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	3	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																								37		37				37		30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_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												
S5884	145	0		29	10	S5884_145_0	4	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	4	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	145	0		29	10	S5884_145_0	4	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				26.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	4	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				61.00	39		39																								39		39				39		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	4	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												
S5884	146	0		29	10	S5884_146_0	4	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	4	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	146	0		29	10	S5884_146_0	4	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				29.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	4	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				65.00	42		42																								42		42				42		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	4	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												
S5884	147	0		29	10	S5884_147_0	3	Preferred Generic	2	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				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	3	Generic	2	11	1	2	2	1	110		01		110	1	30		90				2	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												
S5884	147	0		29	10	S5884_147_0	3	Preferred Brand	2	11	1	1	3	1	110		01		110	1	30		90				2	2				30		90	30		31				26.00	25		25																								25		25				25		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	3	Non-Preferred Drug	2	11	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				62.00	38		38																								38		38				38		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_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												
S5884	148	0		29	10	S5884_148_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					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	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	4	Preferred Brand	4	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		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											69.00	47		47				45.00	35		35										47		47				35		35			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_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												
S5884	149	0		29	10	S5884_149_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												
S5884	149	0		29	10	S5884_149_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	3	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	25		25				26.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											84.00	50		50				53.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_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												
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	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											29.00	25		25				23.00	20		20										25		25				20		14			25			25								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											77.00	49		49				53.00	35		35										49		49				35		35			49			49								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	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												
S5884	151	0		29	10	S5884_151_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	3	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	25		25				25.00	20		20										25		25				20		17			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_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												
S5884	152	0		29	10	S5884_152_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												
S5884	152	0		29	10	S5884_152_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	3	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				24.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_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				49.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_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												
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	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											29.00	25		25				23.00	20		20										25		25				20		20			25			25								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				50.00	35		35										50		50				35		35			50			50								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	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												
S5884	154	0		29	10	S5884_154_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	3	Preferred Brand	4	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		18			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	3	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				47.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_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												
S5884	155	0		29	10	S5884_155_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												
S5884	155	0		29	10	S5884_155_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		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	3	Preferred Brand	4	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		19			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_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												
S5884	156	0		29	10	S5884_156_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												
S5884	156	0		29	10	S5884_156_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	3	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	20		20										25		25				20		14			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	3	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				51.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_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												
S5884	157	0		29	10	S5884_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					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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	3	Preferred Brand	4	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		12			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	48		48				50.00	35		35										48		48				35		30			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_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												
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	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				21.00	20		20										25		25				20		17			25			25								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											69.00	50		50				45.00	35		35										50		50				35		35			50			50								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	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												
S5884	159	0		29	10	S5884_159_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	3	Preferred Brand	4	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		18			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	3	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				47.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_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												
S5884	160	0		29	10	S5884_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					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	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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	3	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				47.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_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												
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	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				22.00	20		20										25		25				20		19			25			25								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											70.00	50		50				46.00	35		35										50		50				35		35			50			50								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	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											31.00	25		25				26.00	21		21										25		25				21		20			25			25								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											76.00	50		50				49.00	35		35										50		50				35		35			50			50								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	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												
S5884	163	0		29	10	S5884_163_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	3	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				24.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_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				48.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_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												
S5884	164	0		29	10	S5884_164_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												
S5884	164	0		29	10	S5884_164_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_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												
S5884	165	0		29	10	S5884_165_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												
S5884	165	0		29	10	S5884_165_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	3	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				21.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_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				43.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_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												
S5884	166	0		29	10	S5884_166_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												
S5884	166	0		29	10	S5884_166_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	3	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				21.00	20		20										25		25				20		17			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	3	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				40.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_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												
S5884	167	0		29	10	S5884_167_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	167	0		29	10	S5884_167_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		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2	Preferred Brand	4	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		16			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2	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				43.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_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	168	0		29	10	S5884_168_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	168	0		29	10	S5884_168_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_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				23.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_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				48.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_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	169	0		29	10	S5884_169_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	169	0		29	10	S5884_169_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_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				23.00	20		20										25		25				20		14			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_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				50.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_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	170	0		29	10	S5884_170_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	170	0		29	10	S5884_170_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_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				22.00	20		20										25		25				20		17			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2	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				44.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_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	171	0		29	10	S5884_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					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	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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	3	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				24.00	20		20										25		25				20		17			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	3	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				51.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_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												
S5884	172	0		29	10	S5884_172_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												
S5884	172	0		29	10	S5884_172_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	3	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	25		25				25.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_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				51.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_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												
S5884	173	0		29	10	S5884_173_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	173	0		29	10	S5884_173_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_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				23.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											93.00	50		50				64.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_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	174	0		29	10	S5884_174_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												
S5884	174	0		29	10	S5884_174_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	3	Preferred Brand	4	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		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	3	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				50.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_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												
S5884	175	0		29	10	S5884_175_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		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	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_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	20		20										25		25				20		13			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	48		48				57.00	35		35										48		48				35		35			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_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	176	0		29	10	S5884_176_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												
S5884	176	0		29	10	S5884_176_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	3	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	20		20										25		25				20		17			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_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				45.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_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												
S5884	177	0		29	10	S5884_177_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	177	0		29	10	S5884_177_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_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	20		20										25		25				20		17			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2	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				44.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_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	178	0		29	10	S5884_178_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	178	0		29	10	S5884_178_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_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				22.00	20		20										25		25				20		9			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_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	179	0		29	10	S5884_179_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												
S5884	179	0		29	10	S5884_179_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	3	Preferred Brand	4	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		13			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_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	45		45				55.00	35		35										45		45				35		35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_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												
S5884	180	0		29	10	S5884_180_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												
S5884	180	0		29	10	S5884_180_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		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	3	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	25		25				29.00	20		20										25		25				20		18			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	3	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				43.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_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												
S5904	001	0		29	10	S5904_001_0	6	Preferred Generic	3	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												
S5904	001	0		29	10	S5904_001_0	6	Generic	3	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	6.00		18.00																			6.00		18.00																6.00				6.00		0.19			0.19			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	6	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				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	6	Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				98.48	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	6	Specialty Tier	3	11	1	1	5	1	010		01	010		1	31								31						31		31				799.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	6	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	6	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	6	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	6	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	6	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	6	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	6	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												
S5904	006	0		29	10	S5904_006_0	7	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 Drug, Specialty Tier, Select Care Drugs												
S5904	006	0		29	10	S5904_006_0	7	Generic	4	11	1	2	2	1	110		01	110		1	31		90				1	1	31		90				31		31	13.00		39.00																			13.00		39.00																13.00				13.00		0.42			0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5904	006	0		29	10	S5904_006_0	7	Preferred Brand	4	11	1	1	3	1	110		01	110		1	31		90				1	1	31		90				31		31				30.86	20		20																		20		20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5904	006	0		29	10	S5904_006_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	31		90				1	1	31		90				31		31				48.99	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5904	006	0		29	10	S5904_006_0	7	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				768.79	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5904	006	0		29	10	S5904_006_0	7	Select Care Drugs	4	01	1	2	6	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 Drug, Specialty Tier, Select Care Drugs												
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								17.00	34.00	34.00					10.00	20.00	20.00					10.00	20.00	20.00																17.00				17.00			0.57	0.33	0.33			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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								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												
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					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												
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											69.65	35	35	35				59.70	30	30	30				30	30	30															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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											1352.40	28						1352.40	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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	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 Drug, Specialty Tier												
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	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 Drug, Specialty Tier										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	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												
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	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												
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				79.60	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
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				1593.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	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	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				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	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	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	2	2						90	30		31											66.00	33		33				66.00	33		33												33						33			33			33								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	2	2						90	30		31											658.00	25		25				658.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	349	0		29	10	S5921_349_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	33		33				73.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											634.00	25		25				634.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	33		33				72.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											612.00	25		25				612.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	33		33				69.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											709.00	25		25				709.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	4	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				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	4	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	4	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	33		33				69.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	4	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											643.00	25		25				643.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	353	0		29	10	S5921_353_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	33		33				76.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											718.00	25		25				718.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				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	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	354	0		29	10	S5921_354_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								36.00		108.00					31.00		93.00													108.00						93.00				36.00				36.00			1.20	1.03				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	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	354	0		29	10	S5921_354_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											766.00	25		25				766.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	355	0		29	10	S5921_355_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								32.00		96.00					27.00		81.00													96.00						81.00				32.00				32.00			1.06	0.90				1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											68.00	33		33				68.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											677.00	25		25				677.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	356	0		29	10	S5921_356_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								31.00		93.00					26.00		78.00													93.00						78.00				31.00				31.00			1.03	0.86				1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	33		33				71.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											670.00	25		25				670.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	33		33				72.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											713.00	25		25				713.00	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	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	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	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	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	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	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	2	2						90	30		31											58.00	27		27				58.00	27		27												27						27			27			27								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	2	2						90	30		31											740.00	25		25				740.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											70.00	33		33				70.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											679.00	25		25				679.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	33		33				71.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											759.00	25		25				759.00	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	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	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	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	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	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	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	2	2						90	30		31											71.00	33		33				71.00	33		33												33						33			33			33								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	2	2						90	30		31											761.00	25		25				761.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	362	0		29	10	S5921_362_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											66.00	33		33				66.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											669.00	25		25				669.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	363	0		29	10	S5921_363_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								31.00		93.00					26.00		78.00													93.00						78.00				31.00				31.00			1.03	0.86				1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	33		33				69.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											723.00	25		25				723.00	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	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	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	2	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												
S5921	364	0		29	10	S5921_364_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	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	2	2						90	30		31											70.00	33		33				70.00	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	2	2						90	30		31											748.00	25		25				748.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				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	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											64.00	33		33				64.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											812.00	25		25				812.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	4	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	4	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	4	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	33		33				71.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	4	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											655.00	25		25				655.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	367	0		29	10	S5921_367_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								35.00		105.00					30.00		90.00													105.00						90.00				35.00				35.00			1.16	1.00				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	33		33				71.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											741.00	25		25				741.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											70.00	30		30				70.00	30		30												30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	3	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	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	369	0		29	10	S5921_369_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	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	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				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	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	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	2	2						90	30		31											71.00	33		33				71.00	33		33												33						33			33			33								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	2	2						90	30		31											716.00	25		25				716.00	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	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				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	2	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												
S5921	370	0		29	10	S5921_370_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	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	2	2						90	30		31											67.00	33		33				67.00	33		33												33						33			33			33								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	2	2						90	30		31											674.00	25		25				674.00	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	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	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	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	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	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	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	2	2						90	30		31											59.00	33		33				59.00	33		33												33						33			33			33								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	2	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	372	0		29	10	S5921_372_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	372	0		29	10	S5921_372_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								32.00		96.00					27.00		81.00													96.00						81.00				32.00				32.00			1.06	0.90				1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	33		33				71.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											716.00	25		25				716.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	373	0		29	10	S5921_373_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	33		33				74.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											522.00	25		25				522.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	374	0		29	10	S5921_374_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											66.00	33		33				66.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											712.00	25		25				712.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	375	0		29	10	S5921_375_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											70.00	33		33				70.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											793.00	25		25				793.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	31		31				72.00	31		31												31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											564.00	25		25				564.00	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	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	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	2	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												
S5921	377	0		29	10	S5921_377_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								31.00		93.00					26.00		78.00													93.00						78.00				31.00				31.00			1.03	0.86				1.00	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	2	2						90	30		31											61.00	33		33				61.00	33		33												33						33			33			33								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	2	2						90	30		31											556.00	25		25				556.00	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	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	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	2	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												
S5921	378	0		29	10	S5921_378_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	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	2	2						90	30		31											67.00	33		33				67.00	33		33												33						33			33			33								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	2	2						90	30		31											652.00	25		25				652.00	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	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	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	2	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												
S5921	379	0		29	10	S5921_379_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	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	2	2						90	30		31											75.00	33		33				75.00	33		33												33						33			33			33								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	2	2						90	30		31											688.00	25		25				688.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	380	0		29	10	S5921_380_0	3	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								34.00		102.00					29.00		87.00													102.00						87.00				34.00				34.00			1.13	0.96				1.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											70.00	33		33				70.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											636.00	25		25				636.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	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												
S5921	381	0		29	10	S5921_381_0	2	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								32.00		96.00					27.00		81.00													96.00						81.00				32.00				32.00			1.06	0.90				1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											90.00	33		33				90.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	Specialty Tier	2	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											556.00	25		25				556.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											78.00	32		32				78.00	32		32												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											784.00	25		25				784.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											98.00	33		33				69.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											897.00	25		25				897.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											64.00	33		33				58.00	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	2	2						90	30		31											872.00	25		25				872.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	33		33				59.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											856.00	25		25				856.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											93.00	33		33				66.00	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	2	2						90	30		31											608.00	25		25				608.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											79.00	33		33				59.00	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	2	2						90	30		31											886.00	25		25				886.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	388	0		29	10	S5921_388_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	388	0		29	10	S5921_388_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	388	0		29	10	S5921_388_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											88.00	33		33				64.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	388	0		29	10	S5921_388_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											1019.00	25		25				1019.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											91.00	33		33				65.00	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	2	2						90	30		31											745.00	25		25				745.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											87.00	33		33				60.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											723.00	25		25				723.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											91.00	33		33				65.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	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	392	0		29	10	S5921_392_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	392	0		29	10	S5921_392_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	392	0		29	10	S5921_392_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	33		33				60.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	392	0		29	10	S5921_392_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	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	393	0		29	10	S5921_393_0	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	3	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	393	0		29	10	S5921_393_0	3	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	393	0		29	10	S5921_393_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	33		33				59.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	393	0		29	10	S5921_393_0	3	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											789.00	25		25				789.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											79.00	33		33				57.00	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	2	2						90	30		31											894.00	25		25				894.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											84.00	33		33				55.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	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	396	0		29	10	S5921_396_0	1	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											83.00	33		33				64.00	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	2	2						90	30		31											1001.00	25		25				1001.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											72.00	33		33				53.00	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	2	2						90	30		31											963.00	25		25				963.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											85.00	33		33				62.00	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	2	2						90	30		31											867.00	25		25				867.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											83.00	33		33				61.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											872.00	25		25				872.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											78.00	32		32				78.00	32		32												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											760.00	25		25				760.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	401	0		29	10	S5921_401_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	401	0		29	10	S5921_401_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	401	0		29	10	S5921_401_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											65.00	33		33				50.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	401	0		29	10	S5921_401_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											827.00	25		25				827.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	33		33				57.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											708.00	25		25				708.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											87.00	33		33				62.00	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	2	2						90	30		31											913.00	25		25				913.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											79.00	33		33				65.00	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	2	2						90	30		31											1077.00	25		25				1077.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	33		33				54.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											1010.00	25		25				1010.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											79.00	33		33				58.00	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	2	2						90	30		31											981.00	25		25				981.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											99.00	33		33				76.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											1140.00	25		25				1140.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											82.00	33		33				65.00	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	2	2						90	30		31											1084.00	25		25				1084.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											92.00	33		33				66.00	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	2	2						90	30		31											848.00	25		25				848.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											91.00	33		33				69.00	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	2	2						90	30		31											923.00	25		25				923.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	33		33				54.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											957.00	25		25				957.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											71.00	33		33				55.00	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	2	2						90	30		31											1101.00	25		25				1101.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											81.00	33		33				60.00	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	2	2						90	30		31											802.00	25		25				802.00	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	2	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	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				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	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	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	2	2						90	30		31											76.00	32		32				76.00	32		32												32						32			32			32								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	2	2						90	30		31											832.00	25		25				832.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	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	2	Generic	4	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		15.00													60.00						15.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	2	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					30.00		90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											91.00	33		33				66.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	2	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											1104.00	25		25				1104.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	5	Preferred Generic	3	11	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											9.00	18.00	27.00				4.00	8.00	10.00				9.00				4.00			0.30	0.13		0.30	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	5	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											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	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	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	5	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											59.82	50	50	50				53.84	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	5	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	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	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	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	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	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					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	4	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	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	4	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	4	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											55.73	45	45	45				49.54	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	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 Drug, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					1.00		3.00													2.00						2.00				9.00				9.00			0.30	0.03				0.29	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				30		90	1	2						90	30		31								12.00		36.00					3.00		9.00													6.00						6.00				12.00				12.00			0.40	0.10				0.39	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				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													75.00						75.00				35.00				35.00			1.17	0.83				1.13	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				30								30			30		31											65.05	41						61.61	39												43						41					41			41								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				30								30			30		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	3	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													0.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	3	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					7.00		21.00													4.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	006	0		29	10	S5983_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													126.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	3	Preferred Brand	4	11	1	1	3	3		110	01		100	1				30		90	1	2						90	30		31											158.10	50		50				143.14	45		45												50						45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5983	006	0		29	10	S5983_006_0	3	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											99.98	50						94.68	48												52						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	006	0		29	10	S5983_006_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												
S5983	007	0		29	10	S5983_007_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					1.00		3.00													2.00						2.00				10.00				10.00			0.33	0.03				0.32	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				30		90	1	2						90	30		31								13.00		39.00					4.00		12.00													8.00						8.00				13.00				13.00			0.43	0.13				0.42	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				30		90	1	2						90	30		31											36.22	21		21				31.08	18		18												18						18			21			21								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				30								30			30		31											45.49	34						40.10	32												36						34					34			34								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				30								30			30		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	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					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 Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	2	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 Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	2	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					32.00	64.00	96.00					32.00	64.00	96.00																40.00				40.00			1.33	1.07	1.07			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_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											91.72	30	30	30				76.43	25	25	25				25	25	25															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	2	Specialty Tier	2	11	1	1	5	1		010	01			1				30											30		31											1252.07	25						1252.07	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_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								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 Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	2	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 Drug, Specialty Tier										1		
S5993	003	0		29	10	S5993_003_0	2	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 Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	2	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 Drug, Specialty Tier										1		
S5993	003	0		29	10	S5993_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								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 Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_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											73.01	30	30	30				60.84	25	25	25				25	25	25															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	2	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1590.08	33						1590.08	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	2	Preferred Generic	2	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					3.00	6.00	9.00											6.00	12.00	18.00				3.00	6.00	9.00				6.00				6.00			0.20	0.10		0.20	0.10	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	2	Generic	2	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					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00				12.00				12.00			0.40	0.20		0.40	0.20	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	2	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											23.19	21	21	21				19.62	16	16	16										21	21	21				16	16	16			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_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											76.98	40	40	40				70.75	33	33	33										40	40	40				33	33	33			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_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												
S6506	002	0		29	10	S6506_002_0	2	Preferred Generic	4	11	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	2	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	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	2	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											41.82	25	25	25				40.87	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	2	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.54	50	50	50				97.25	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_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												
S6506	003	0		29	10	S6506_003_0	2	Preferred Generic	4	11	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 Drug, Specialty Tier												
S6506	003	0		29	10	S6506_003_0	2	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					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	003	0		29	10	S6506_003_0	2	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											25.63	24	24	24				17.84	15	15	15										24	24	24				15	15	15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	003	0		29	10	S6506_003_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											99.77	48	48	48				81.20	35	35	35										48	48	48				35	35	35			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	003	0		29	10	S6506_003_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												
S6986	001	0		29	10	S6986_001_0	1	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	12.00					2.00	4.00	4.00											6.00	12.00	12.00				2.00	4.00	4.00				6.00				6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	001	0		29	10	S6986_001_0	1	Generic	2	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					6.00	12.00	12.00											10.00	20.00	20.00				6.00	12.00	12.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	001	0		29	10	S6986_001_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											22.49	20	20	20				14.15	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	001	0		29	10	S6986_001_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.71	35	35	35				58.35	32	32	32										35	35	35				32	32	32			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	001	0		29	10	S6986_001_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												
S6986	002	0		29	10	S6986_002_0	1	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	12.00					2.00	4.00	4.00											6.00	12.00	12.00				2.00	4.00	4.00				6.00				6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	002	0		29	10	S6986_002_0	1	Generic	2	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					6.00	12.00	12.00											10.00	20.00	20.00				6.00	12.00	12.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	002	0		29	10	S6986_002_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											22.27	20	20	20				14.01	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	002	0		29	10	S6986_002_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.98	35	35	35				58.56	32	32	32										35	35	35				32	32	32			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	002	0		29	10	S6986_002_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												
S6986	003	0		29	10	S6986_003_0	1	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	12.00					2.00	4.00	4.00											6.00	12.00	12.00				2.00	4.00	4.00				6.00				6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	003	0		29	10	S6986_003_0	1	Generic	2	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					6.00	12.00	12.00											10.00	20.00	20.00				6.00	12.00	12.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	003	0		29	10	S6986_003_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											22.68	20	20	20				14.27	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	003	0		29	10	S6986_003_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.17	35	35	35				57.93	32	32	32										35	35	35				32	32	32			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	003	0		29	10	S6986_003_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												
S6986	004	0		29	10	S6986_004_0	1	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	12.00					2.00	4.00	4.00											6.00	12.00	12.00				2.00	4.00	4.00				6.00				6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	004	0		29	10	S6986_004_0	1	Generic	2	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					6.00	12.00	12.00											10.00	20.00	20.00				6.00	12.00	12.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	004	0		29	10	S6986_004_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											22.45	20	20	20				14.12	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	004	0		29	10	S6986_004_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.60	35	35	35				58.27	32	32	32										35	35	35				32	32	32			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	004	0		29	10	S6986_004_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												
S6986	006	0		29	10	S6986_006_0	1	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	12.00					2.00	4.00	4.00											6.00	12.00	12.00				2.00	4.00	4.00				6.00				6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	006	0		29	10	S6986_006_0	1	Generic	2	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					6.00	12.00	12.00											10.00	20.00	20.00				6.00	12.00	12.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	006	0		29	10	S6986_006_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											22.45	20	20	20				14.12	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	006	0		29	10	S6986_006_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.60	35	35	35				58.27	32	32	32										35	35	35				32	32	32			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	006	0		29	10	S6986_006_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												
S6986	007	0		29	10	S6986_007_0	1	Preferred Generic	2	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	12.00					2.00	4.00	4.00											6.00	12.00	12.00				2.00	4.00	4.00				6.00				6.00			0.20	0.07		0.20	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	007	0		29	10	S6986_007_0	1	Generic	2	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					6.00	12.00	12.00											10.00	20.00	20.00				6.00	12.00	12.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	007	0		29	10	S6986_007_0	1	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											22.45	20	20	20				14.12	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	007	0		29	10	S6986_007_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.60	35	35	35				58.27	32	32	32										35	35	35				32	32	32			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	007	0		29	10	S6986_007_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												
S6986	008	0		29	10	S6986_008_0	1	Preferred Generic	4	11	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 Drug, Specialty Tier												
S6986	008	0		29	10	S6986_008_0	1	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					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	008	0		29	10	S6986_008_0	1	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											27.37	24	24	24				16.97	15	15	15										24	24	24				15	15	15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	008	0		29	10	S6986_008_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											98.19	44	44	44				77.78	35	35	35										44	44	44				35	35	35			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	008	0		29	10	S6986_008_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												
S6986	009	0		29	10	S6986_009_0	1	Preferred Generic	4	11	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 Drug, Specialty Tier												
S6986	009	0		29	10	S6986_009_0	1	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					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	009	0		29	10	S6986_009_0	1	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											27.37	24	24	24				16.97	15	15	15										24	24	24				15	15	15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	009	0		29	10	S6986_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		31											98.19	44	44	44				77.78	35	35	35										44	44	44				35	35	35			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	009	0		29	10	S6986_009_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												
S6986	010	0		29	10	S6986_010_0	1	Preferred Generic	4	11	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 Drug, Specialty Tier												
S6986	010	0		29	10	S6986_010_0	1	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					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	010	0		29	10	S6986_010_0	1	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											27.37	24	24	24				16.97	15	15	15										24	24	24				15	15	15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	010	0		29	10	S6986_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		31											98.19	44	44	44				77.78	35	35	35										44	44	44				35	35	35			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	010	0		29	10	S6986_010_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												
S6986	011	0		29	10	S6986_011_0	1	Preferred Generic	4	11	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 Drug, Specialty Tier												
S6986	011	0		29	10	S6986_011_0	1	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					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	011	0		29	10	S6986_011_0	1	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											27.37	24	24	24				16.97	15	15	15										24	24	24				15	15	15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	011	0		29	10	S6986_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		31											98.19	44	44	44				77.78	35	35	35										44	44	44				35	35	35			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	011	0		29	10	S6986_011_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												
S6986	012	0		29	10	S6986_012_0	1	Preferred Generic	4	11	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 Drug, Specialty Tier												
S6986	012	0		29	10	S6986_012_0	1	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					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	012	0		29	10	S6986_012_0	1	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											27.37	24	24	24				16.97	15	15	15										24	24	24				15	15	15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	012	0		29	10	S6986_012_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											98.19	44	44	44				77.77	35	35	35										44	44	44				35	35	35			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	012	0		29	10	S6986_012_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												
S6986	013	0		29	10	S6986_013_0	1	Preferred Generic	4	11	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 Drug, Specialty Tier												
S6986	013	0		29	10	S6986_013_0	1	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					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	013	0		29	10	S6986_013_0	1	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											27.37	24	24	24				16.97	15	15	15										24	24	24				15	15	15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	013	0		29	10	S6986_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		31											98.19	44	44	44				77.77	35	35	35										44	44	44				35	35	35			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	013	0		29	10	S6986_013_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												
S7126	001	0		29	10	S7126_001_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					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	2	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	2	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													85.00						85.00				40.00				40.00			1.33	1.00				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	2	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											47.53	50						41.73	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_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												
S7126	002	0		29	10	S7126_002_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					7.00		21.00													18.00						18.00				13.00				13.00			0.43	0.23				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_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													97.00						97.00				44.00				44.00			1.47	1.13				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											43.78	50						37.76	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_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												
S7126	003	0		29	10	S7126_003_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_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													91.00						91.00				42.00				42.00			1.40	1.07				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											44.23	50						39.30	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_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												
S7126	004	0		29	10	S7126_004_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_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													94.00						94.00				43.00				43.00			1.43	1.10				1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											44.08	50						39.11	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_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												
S7126	005	0		29	10	S7126_005_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_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													94.00						94.00				43.00				43.00			1.43	1.10				1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											42.15	50						36.94	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_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												
S7126	006	0		29	10	S7126_006_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					6.00		18.00													15.00						15.00				13.00				13.00			0.43	0.20				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1	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													100.00						100.00				45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											45.19	50						39.30	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_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												
S7126	007	0		29	10	S7126_007_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_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													91.00						91.00				42.00				42.00			1.40	1.07				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											46.03	50						40.01	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_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												
S7126	008	0		29	10	S7126_008_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	1	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													100.00						100.00				45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											44.77	50						38.31	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_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												
S7126	009	0		29	10	S7126_009_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_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													94.00						94.00				43.00				43.00			1.43	1.10				1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											46.39	50						40.72	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_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												
S7126	010	0		29	10	S7126_010_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_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													94.00						94.00				43.00				43.00			1.43	1.10				1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											44.84	50						39.07	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_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												
S7126	011	0		29	10	S7126_011_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_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													85.00						85.00				40.00				40.00			1.33	1.00				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											45.81	50						39.90	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_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												
S7126	012	0		29	10	S7126_012_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_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													88.00						88.00				41.00				41.00			1.37	1.03				1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											43.01	50						37.79	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_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												
S7126	013	0		29	10	S7126_013_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_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													97.00						97.00				44.00				44.00			1.47	1.13				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											42.28	50						37.19	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_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												
S7126	014	0		29	10	S7126_014_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_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													97.00						97.00				44.00				44.00			1.47	1.13				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											44.24	50						38.24	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_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												
S7126	015	0		29	10	S7126_015_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_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													67.00						67.00				34.00				34.00			1.13	0.80				1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											35.82	50						31.49	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_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												
S7126	016	0		29	10	S7126_016_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_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													82.00						82.00				39.00				39.00			1.30	0.97				1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											44.62	50						38.96	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_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												
S7126	017	0		29	10	S7126_017_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_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													76.00						76.00				37.00				37.00			1.23	0.90				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											42.59	50						36.37	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_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												
S7126	018	0		29	10	S7126_018_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_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													64.00						64.00				33.00				33.00			1.10	0.77				1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											40.79	50						33.74	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_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												
S7126	019	0		29	10	S7126_019_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_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													79.00						79.00				38.00				38.00			1.27	0.93				1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											47.50	50						41.57	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_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												
S7126	020	0		29	10	S7126_020_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_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													76.00						76.00				37.00				37.00			1.23	0.90				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											45.92	50						39.88	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_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												
S7126	021	0		29	10	S7126_021_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_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													88.00						88.00				41.00				41.00			1.37	1.03				1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											42.50	50						37.31	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_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												
S7126	022	0		29	10	S7126_022_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_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													82.00						82.00				39.00				39.00			1.30	0.97				1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											45.24	50						38.29	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_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												
S7126	023	0		29	10	S7126_023_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_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													94.00						94.00				43.00				43.00			1.43	1.10				1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											40.91	50						35.82	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_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												
S7126	024	0		29	10	S7126_024_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								31.00		93.00					21.00		63.00													58.00						58.00				31.00				31.00			1.03	0.70				1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											35.32	50						30.84	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_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												
S7126	025	0		29	10	S7126_025_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_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													76.00						76.00				37.00				37.00			1.23	0.90				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											43.21	50						36.53	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_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												
S7126	026	0		29	10	S7126_026_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_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													106.00						106.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											44.42	50						38.47	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_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												
S7126	027	0		29	10	S7126_027_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					7.00		21.00													18.00						18.00				13.00				13.00			0.43	0.23				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_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													97.00						97.00				44.00				44.00			1.47	1.13				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											41.27	50						35.92	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_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												
S7126	028	0		29	10	S7126_028_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_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													106.00						106.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											48.42	50						41.53	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_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												
S7126	029	0		29	10	S7126_029_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													70.00						70.00				35.00				35.00			1.17	0.83				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											40.51	50						34.46	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_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												
S7126	030	0		29	10	S7126_030_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_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													91.00						91.00				42.00				42.00			1.40	1.07				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											41.59	50						35.95	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_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												
S7126	031	0		29	10	S7126_031_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_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													97.00						97.00				44.00				44.00			1.47	1.13				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											43.67	50						37.93	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_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												
S7126	032	0		29	10	S7126_032_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													15.00						15.00				12.00				12.00			0.40	0.20				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_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													106.00						106.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											48.91	50						42.31	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_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												
S7126	033	0		29	10	S7126_033_0	1	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													8.00						8.00				8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	1	Generic	2	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					5.00		15.00													12.00						12.00				11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_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													79.00						79.00				38.00				38.00			1.27	0.93				1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	1	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											53.31	50						45.48	48												48						48					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_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												
S7126	034	0		29	10	S7126_034_0	2	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	034	0		29	10	S7126_034_0	2	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	034	0		29	10	S7126_034_0	2	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											31.89	18		18				26.61	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	034	0		29	10	S7126_034_0	2	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											54.22	38						48.70	35												38						38					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	034	0		29	10	S7126_034_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												
S7126	035	0		29	10	S7126_035_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	035	0		29	10	S7126_035_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	035	0		29	10	S7126_035_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.61	18		18				27.02	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	035	0		29	10	S7126_035_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											59.99	40						53.08	37												42						40					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	035	0		29	10	S7126_035_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												
S7126	036	0		29	10	S7126_036_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	036	0		29	10	S7126_036_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	036	0		29	10	S7126_036_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.74	18		18				27.49	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	036	0		29	10	S7126_036_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											56.31	39						51.39	36												41						39					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	036	0		29	10	S7126_036_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												
S7126	037	0		29	10	S7126_037_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	037	0		29	10	S7126_037_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	037	0		29	10	S7126_037_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.85	18		18				27.72	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	037	0		29	10	S7126_037_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											56.66	38						51.19	35												40						38					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	037	0		29	10	S7126_037_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												
S7126	038	0		29	10	S7126_038_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	038	0		29	10	S7126_038_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	038	0		29	10	S7126_038_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.06	18		18				26.71	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	038	0		29	10	S7126_038_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											55.64	39						50.15	36												41						39					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	038	0		29	10	S7126_038_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												
S7126	039	0		29	10	S7126_039_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	039	0		29	10	S7126_039_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	039	0		29	10	S7126_039_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.42	18		18				27.07	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	039	0		29	10	S7126_039_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											58.16	40						52.33	37												42						40					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	039	0		29	10	S7126_039_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												
S7126	040	0		29	10	S7126_040_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	040	0		29	10	S7126_040_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	040	0		29	10	S7126_040_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.27	18		18				26.86	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	040	0		29	10	S7126_040_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											56.78	39						50.76	36												41						39					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	040	0		29	10	S7126_040_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												
S7126	041	0		29	10	S7126_041_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	041	0		29	10	S7126_041_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	041	0		29	10	S7126_041_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											31.48	18		18				26.08	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	041	0		29	10	S7126_041_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											56.71	40						50.48	37												42						40					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	041	0		29	10	S7126_041_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												
S7126	042	0		29	10	S7126_042_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	042	0		29	10	S7126_042_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	042	0		29	10	S7126_042_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.58	18		18				27.26	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	042	0		29	10	S7126_042_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											58.08	39						51.93	36												41						39					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	042	0		29	10	S7126_042_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												
S7126	043	0		29	10	S7126_043_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	043	0		29	10	S7126_043_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	043	0		29	10	S7126_043_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											31.86	18		18				26.58	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	043	0		29	10	S7126_043_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											56.70	39						50.56	36												41						39					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	043	0		29	10	S7126_043_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												
S7126	044	0		29	10	S7126_044_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	044	0		29	10	S7126_044_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	044	0		29	10	S7126_044_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.23	18		18				26.86	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	044	0		29	10	S7126_044_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											55.54	38						49.55	35												40						38					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	044	0		29	10	S7126_044_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												
S7126	045	0		29	10	S7126_045_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	045	0		29	10	S7126_045_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	045	0		29	10	S7126_045_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											31.79	18		18				26.69	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	045	0		29	10	S7126_045_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											53.92	38						48.66	35												40						38					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	045	0		29	10	S7126_045_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												
S7126	046	0		29	10	S7126_046_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	046	0		29	10	S7126_046_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	046	0		29	10	S7126_046_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											31.52	18		18				26.45	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	046	0		29	10	S7126_046_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											56.19	40						51.02	37												42						40					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	046	0		29	10	S7126_046_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												
S7126	047	0		29	10	S7126_047_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	047	0		29	10	S7126_047_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	047	0		29	10	S7126_047_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											31.59	18		18				26.29	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	047	0		29	10	S7126_047_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											56.67	40						50.80	37												42						40					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	047	0		29	10	S7126_047_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												
S7126	048	0		29	10	S7126_048_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	048	0		29	10	S7126_048_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	048	0		29	10	S7126_048_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											30.13	18		18				25.10	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	048	0		29	10	S7126_048_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											47.10	36						42.48	33												38						36					36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	048	0		29	10	S7126_048_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												
S7126	049	0		29	10	S7126_049_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	049	0		29	10	S7126_049_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	049	0		29	10	S7126_049_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											30.98	18		18				25.81	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	049	0		29	10	S7126_049_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											53.82	39						48.40	36												41						39					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	049	0		29	10	S7126_049_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												
S7126	050	0		29	10	S7126_050_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	050	0		29	10	S7126_050_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	050	0		29	10	S7126_050_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											31.08	18		18				25.90	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	050	0		29	10	S7126_050_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											50.76	37						45.59	34												39						37					37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	050	0		29	10	S7126_050_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												
S7126	051	0		29	10	S7126_051_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	051	0		29	10	S7126_051_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	051	0		29	10	S7126_051_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											30.97	18		18				25.70	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	051	0		29	10	S7126_051_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											49.11	35						42.77	32												37						35					35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	051	0		29	10	S7126_051_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												
S7126	052	0		29	10	S7126_052_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	052	0		29	10	S7126_052_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	052	0		29	10	S7126_052_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											30.77	18		18				25.50	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	052	0		29	10	S7126_052_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											51.77	37						45.69	34												37						37					37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	052	0		29	10	S7126_052_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												
S7126	053	0		29	10	S7126_053_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	053	0		29	10	S7126_053_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	053	0		29	10	S7126_053_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											31.04	18		18				25.85	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	053	0		29	10	S7126_053_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											51.58	36						45.34	33												38						36					36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	053	0		29	10	S7126_053_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												
S7126	054	0		29	10	S7126_054_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	054	0		29	10	S7126_054_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	054	0		29	10	S7126_054_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											31.62	18		18				26.53	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	054	0		29	10	S7126_054_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											55.65	39						50.07	36												41						39					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	054	0		29	10	S7126_054_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												
S7126	055	0		29	10	S7126_055_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	055	0		29	10	S7126_055_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	055	0		29	10	S7126_055_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											31.73	18		18				26.35	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	055	0		29	10	S7126_055_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											52.69	37						46.77	34												39						37					37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	055	0		29	10	S7126_055_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												
S7126	056	0		29	10	S7126_056_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	056	0		29	10	S7126_056_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	056	0		29	10	S7126_056_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											31.16	18		18				26.00	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	056	0		29	10	S7126_056_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											52.32	38						47.21	35												40						38					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	056	0		29	10	S7126_056_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												
S7126	057	0		29	10	S7126_057_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	057	0		29	10	S7126_057_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	057	0		29	10	S7126_057_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											29.55	18		18				24.44	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	057	0		29	10	S7126_057_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											45.11	35						40.24	32												37						35					35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	057	0		29	10	S7126_057_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												
S7126	058	0		29	10	S7126_058_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	058	0		29	10	S7126_058_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	058	0		29	10	S7126_058_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											30.97	18		18				25.59	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	058	0		29	10	S7126_058_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											51.56	36						44.86	33												38						36					36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	058	0		29	10	S7126_058_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												
S7126	059	0		29	10	S7126_059_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	059	0		29	10	S7126_059_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	059	0		29	10	S7126_059_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.77	18		18				27.20	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	059	0		29	10	S7126_059_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											58.75	40						52.71	37												42						40					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	059	0		29	10	S7126_059_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												
S7126	060	0		29	10	S7126_060_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	060	0		29	10	S7126_060_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	060	0		29	10	S7126_060_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.12	18		18				26.68	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	060	0		29	10	S7126_060_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											58.11	41						52.47	38												43						41					41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	060	0		29	10	S7126_060_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												
S7126	061	0		29	10	S7126_061_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	061	0		29	10	S7126_061_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	061	0		29	10	S7126_061_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.02	18		18				26.46	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	061	0		29	10	S7126_061_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											58.15	40						51.49	37												42						40					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	061	0		29	10	S7126_061_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												
S7126	062	0		29	10	S7126_062_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	062	0		29	10	S7126_062_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	062	0		29	10	S7126_062_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											30.57	18		18				25.48	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	062	0		29	10	S7126_062_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											48.64	36						43.55	33												38						36					36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	062	0		29	10	S7126_062_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												
S7126	063	0		29	10	S7126_063_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	063	0		29	10	S7126_063_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	063	0		29	10	S7126_063_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											31.67	18		18				26.35	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	063	0		29	10	S7126_063_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											53.05	38						47.80	35												40						38					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	063	0		29	10	S7126_063_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												
S7126	064	0		29	10	S7126_064_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	064	0		29	10	S7126_064_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	064	0		29	10	S7126_064_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											30.69	18		18				25.54	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	064	0		29	10	S7126_064_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											52.97	38						47.15	35												40						38					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	064	0		29	10	S7126_064_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												
S7126	065	0		29	10	S7126_065_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	065	0		29	10	S7126_065_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	065	0		29	10	S7126_065_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.44	18		18				26.82	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	065	0		29	10	S7126_065_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											60.89	40						53.40	37												42						40					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	065	0		29	10	S7126_065_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												
S7126	066	0		29	10	S7126_066_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					1.00		3.00													2.00						2.00				5.00				5.00			0.17	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	066	0		29	10	S7126_066_0	1	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													8.00						8.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	066	0		29	10	S7126_066_0	1	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											32.73	18		18				26.91	15		15												20						18			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	066	0		29	10	S7126_066_0	1	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											54.41	36						47.01	33												38						36					36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	066	0		29	10	S7126_066_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												
S7694	001	0		29	10	S7694_001_0	1	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					1.00		2.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_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		6.00				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	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					35.00		105.00											47.00		141.00				35.00		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												
S7694	001	0		29	10	S7694_001_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											63.24	44		44				51.74	36		36										44		44				36		36			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											677.09	25						677.09	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	1	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					1.00		2.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_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		6.00				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	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					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	002	0		29	10	S7694_002_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											61.97	42		42				54.59	37		37										42		42				37		37			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											679.00	25						679.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	1	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					1.00		2.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_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		6.00				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	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					35.00		105.00											47.00		141.00				35.00		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												
S7694	003	0		29	10	S7694_003_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											61.94	42		42				51.62	35		35										42		42				35		35			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											640.25	26						640.25	26												26						26					26			26								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											32.06	20		20				24.04	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											58.42	32		32				52.94	29		29										32		32				29		29			32			32								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											731.50	25						731.50	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	1	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					1.00		2.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_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		6.00				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	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					32.00		96.00											47.00		141.00				32.00		96.00				47.00				47.00			1.57	1.07		1.57	1.07	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											61.88	44		44				49.22	35		35										44		44				35		35			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											615.35	25						615.35	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	1	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					1.00		2.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_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		6.00				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	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					35.00		105.00											47.00		141.00				35.00		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												
S7694	006	0		29	10	S7694_006_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											61.48	42		42				51.23	35		35										42		42				35		35			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											663.01	26						663.01	26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_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	007	0		29	10	S7694_007_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	007	0		29	10	S7694_007_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											34.93	20		20				26.20	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											64.80	32		32				58.72	29		29										32		32				29		29			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											702.42	25						702.42	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								19.00		57.00					1.00		2.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	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		6.00				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					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	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											59.38	39		39				54.81	36		36										39		39				36		36			39			39								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											680.80	25						680.80	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	1	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					1.00		2.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_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		6.00				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	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					35.00		105.00											47.00		141.00				35.00		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												
S7694	009	0		29	10	S7694_009_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.48	42		42				52.40	37		37										42		42				37		37			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											737.63	26						737.63	26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	1	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					1.00		2.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_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		6.00				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	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					32.00		96.00											47.00		141.00				32.00		96.00				47.00				47.00			1.57	1.07		1.57	1.07	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											54.78	38		38				50.45	35		35										38		38				35		35			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											614.78	26						614.78	26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_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	011	0		29	10	S7694_011_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	011	0		29	10	S7694_011_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											29.53	20		20				22.15	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											61.14	34		34				50.35	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	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											672.02	25						672.02	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_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	012	0		29	10	S7694_012_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	012	0		29	10	S7694_012_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											33.08	20		20				24.81	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.35	37		37				63.64	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	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											698.60	25						698.60	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	1	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					1.00		2.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_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		6.00				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	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					33.00		99.00											47.00		141.00				33.00		99.00				47.00				47.00			1.57	1.10		1.57	1.10	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.88	40		40				50.90	34		34										40		40				34		34			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											678.35	26						678.35	26												26						26					26			26								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											31.51	20		20				23.63	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											61.86	33		33				58.11	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											699.96	25						699.96	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_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	016	0		29	10	S7694_016_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	016	0		29	10	S7694_016_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											33.57	20		20				25.18	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											52.13	33		33				47.39	30		30										33		33				30		30			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											560.30	25						560.30	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											30.55	20		20				22.91	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											56.62	35		35				51.77	32		32										35		35				32		32			35			35								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											554.19	25						554.19	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	3	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	3	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	3	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											30.94	20		20				23.21	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	3	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											72.49	40		40				63.43	35		35										40		40				35		35			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	3	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											719.98	25						719.98	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_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	019	0		29	10	S7694_019_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	019	0		29	10	S7694_019_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											32.05	20		20				24.04	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											77.74	42		42				72.19	39		39										42		42				39		39			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											758.55	25						758.55	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	1	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					1.00		2.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_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		6.00				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	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					35.00		105.00											47.00		141.00				35.00		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												
S7694	020	0		29	10	S7694_020_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.02	41		41				49.92	33		33										41		41				33		33			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											616.92	25						616.92	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_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	021	0		29	10	S7694_021_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	021	0		29	10	S7694_021_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											33.35	20		20				25.01	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											74.04	38		38				68.20	35		35										38		38				35		35			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											699.95	25						699.95	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_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	022	0		29	10	S7694_022_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	022	0		29	10	S7694_022_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											33.37	20		20				25.02	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											73.77	38		38				67.95	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	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											695.09	25						695.09	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_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	023	0		29	10	S7694_023_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	023	0		29	10	S7694_023_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											32.09	20		20				24.07	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											75.49	40		40				67.94	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	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											679.64	25						679.64	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_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	024	0		29	10	S7694_024_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	024	0		29	10	S7694_024_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											29.30	20		20				21.97	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											68.83	40		40				63.67	37		37										40		40				37		37			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											717.09	25						717.09	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_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	025	0		29	10	S7694_025_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	025	0		29	10	S7694_025_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											31.56	20		20				23.67	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											64.25	35		35				56.91	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	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											688.96	25						688.96	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											32.60	20		20				24.45	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											64.72	39		39				54.76	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											632.98	25						632.98	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											33.97	20		20				25.47	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											54.46	33		33				49.51	30		30										33		33				30		30			33			33								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											536.65	25						536.65	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											31.43	20		20				23.57	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											52.67	33		33				47.88	30		30										33		33				30		30			33			33								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											605.29	25						605.29	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_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	029	0		29	10	S7694_029_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	029	0		29	10	S7694_029_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											30.06	20		20				22.54	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											63.82	36		36				58.51	33		33										36		36				33		33			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											702.25	25						702.25	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	1	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					1.00		2.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_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		6.00				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	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					35.00		105.00											47.00		141.00				35.00		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												
S7694	030	0		29	10	S7694_030_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											56.47	40		40				52.24	37		37										40		40				37		37			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											714.34	25						714.34	25												25						25					25			25								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											28.44	20		20				21.33	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											53.18	34		34				45.36	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											578.58	25						578.58	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	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	032	0		29	10	S7694_032_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		6.00				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	032	0		29	10	S7694_032_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	032	0		29	10	S7694_032_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											60.19	41		41				54.31	37		37										41		41				37		37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											657.37	26						657.37	26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_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	033	0		29	10	S7694_033_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	033	0		29	10	S7694_033_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											33.01	20		20				24.76	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											64.36	39		39				59.41	36		36										39		39				36		36			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											796.24	25						796.24	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											34.03	20		20				25.53	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											53.94	32		32				48.88	29		29										32		32				29		29			32			32								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											546.47	25						546.47	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	1	Preferred Generic	3	01	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					1.00		2.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_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		6.00				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	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					32.00		96.00											47.00		141.00				32.00		96.00				47.00				47.00			1.57	1.07		1.57	1.07	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	1	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											65.85	44		44				56.87	38		38										44		44				38		38			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	1	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											704.27	25						704.27	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	105	0		29	10	S7694_105_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	105	0		29	10	S7694_105_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	105	0		29	10	S7694_105_0	2	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											30.57	20		20				22.92	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	2	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											65.52	40		40				60.60	37		37										40		40				37		37			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	2	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											732.01	25						732.01	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											32.83	20		20				24.62	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											70.60	39		39				65.17	36		36										39		39				36		36			39			39								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											761.48	25						761.48	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	001	0		29	10	S8067_001_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					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												
S8067	001	0		29	10	S8067_001_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		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	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					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												
S8067	001	0		29	10	S8067_001_0	2	Non-Preferred Drug	3	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											80.38	50		50				78.75	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	2	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											744.37	32						744.37	32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	2	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	2	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	2	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	2	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	2	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											401.69	33						401.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
